NCCN Guidelines for Patients
Kidney Cancer, Version 1.2017
Overview of cancer treatments
Surgery | Active surveillance
Before the surgery, you will be asked to stop eating,
drinking, and taking some medications for a short
period of time. If you smoke, it is important to stop.
This surgery is done under general anesthesia—a
controlled loss of wakefulness from drugs. There is
more than one way to perform a radical nephrectomy.
The surgery methods that may be used are
described on page 31.
Risks and side effects of radical nephrectomy
With any type of surgery, there are some health
risks and side effects. A side effect is an unhealthy
or unpleasant condition caused by treatment. Some
possible side effects of a radical nephrectomy include
infections, bleeding, pain from the surgical cuts, and
reduced kidney function. Since the whole kidney
is removed, this surgery also increases the risk for
chronic kidney disease. Chronic kidney disease is
when kidney function slowly gets worse over a long
period of time.
A cytoreductive nephrectomy is surgery to remove
the whole kidney with the primary tumor in the
presence of metastatic disease. Metastatic means
the cancer has spread from where it first formed to
another partof the body and formed new tumors.
New tumors that formed far from the primary tumor
are called metastases. It isn’t possible to remove all
of the cancer from your body with surgery when there
are many metastases. But, removing at least some of
the cancer can still be helpful for some patients.
The goal of cytoreductive surgery is to reduce the
amount of cancer in your body. This surgery may be
used for patients who have many metastases if the
primary tumor can be completely removed. Some
patients may benefit from having a cytoreductive
nephrectomy before treatment with drugs. Removing
the primary tumor may improve how well other
treatments work against the remaining cancer and
A metastasectomy is surgery to remove
metastases—tumors that formed from cancer that
the first tumor. This surgery may be
used when the primary tumor can be completely
removed and there is only one metastasis. But, not
all metastases can be removed by surgery. The
location is a key factor. This approach works best for
metastases in the brain, bone, or lung.
A metastasectomy may be done at the same time
as surgery to remove the primary tumor. Or, it may
be done during a separate operation. The amount of
time needed for the surgery and recovery depends
on many factors. Some factors include the size and
location of the metastasis.
Active surveillance consists of testing on a regular
basis to watch for tumor growth so that treatment can
be started later, if needed, instead of right away. This
may be used for certain patients with a very small
tumor (3 cm or smaller) that is only in the kidney.
Active surveillance may be an option for patients who
are elderly or have other serious health problems.
Such patients may not be healthy enough for surgery
or other cancer treatments. Also, the cancer may not
pose the greatest risk to their health.
All cancer treatments have some health risks and
side effects. Older age and having other health
problems increases the risk of severe side effects
and complications. For these patients, the potential
risks of treatment may be more dangerous than the