Radical or total nephrectomy is the surgical removal of the entire kidney, the fat surrounding the kidney and the adrenal gland, which sits atop the kidney. A partial nephrectomy, in sharp contrast, involves removal of only that portion of the kidney which contains an abnormality, such as a cancer, leaving the remainder of the kidney in place. There is increasing evidence that the preservation of as much healthy, functioning kidney tissue as possible is of significant benefit, particularly in younger patients.
However, it is of vital importance that if kidney-preserving surgery is chosen, all of the cancer must be successfully removed, and careful follow-up undertaken to look for cancer recurrence.
Not all kidney cancers are suitable for treatment by means of a partial nephrectomy. The feasibility of the procedure will depend largely on the size of the tumour and its position within the kidney. This will be discussed in detail with you prior to the procedure.
Please refer to the detailed information provided by the rooms. This information is also available from this website. Because of the involved nature of this procedure, we may arrange a full cardiac review before you undergo the operation.
The procedure will not be performed if you are currently taking, or have recently taken any medication that may interfere with your ability to clot your blood (“blood thinners, aspirin, anti-inflammatory medicines, etc…”). The most common of these medications are aspirin and all related pain relievers or anti-inflammatory compounds (whether prescription or over the counter). Please let us know if you have forgotten to stop these medications as requested.
Partial nephrectomy is most often performed through a flank incision. Whilst keyhole surgery is suitable for total nephrectomy, for technical reasons it is far more difficult to perform a partial nephrectomy via a keyhole approach. Even in the most experienced hands, laparoscopic partial nephrectomy is associated with a higher complication rate than open partial nephrectomy.
After the kidney is exposed, its blood supply is temporarily interrupted by means of specially designed clamps. The kidney is then bathed in ice. This preserves kidney function whilst its blood supply is temporarily halted. This cannot be done via a laparoscopic approach, resulting in a higher risk of losing functioning kidney cells. Once the kidney has been cooled, the cancer is then “carved” out of the kidney and specimens are taken from the kidney for immediate analysis by a pathologist (frozen section analysis) to ensure that no cancer has been left behind. The kidney is then repaired and the blood supply into the kidney is allowed to flow once again. Once it has been established that the kidney is not bleeding from where the tumour was removed, the wound is closed.
After the procedure, your urine will be coming out through a catheter and emptying into a bag. The urine may be crystal clear or appear slightly bloody for a few days. Both are normal findings. You may have drainage tubes attached to bags to empty the excess fluid accumulation in the body from the operation.
A typical hospital stay for these operations is usually about a week depending on your particular health status and your post-operative hospital course. Drains or catheters will be gradually removed. You will be discharged with instructions for follow-up in our office.
When you are seen in the office, the results of the pathology evaluation of the kidney will be discussed. We will then have a better idea of the prognosis and any further treatment that may be required.
Expectations of Outcome
It is normal to feel a bit tired or weak for several weeks. We recommend that you plan for a period of 3-4 weeks off work. For those with jobs that involve strenuous activity, more time may be needed.
Possible Complications of the Procedure
Most patients recover very well after a partial nephrectomy, with no significant problems. Aside from anaesthesia complications, it is important that every patient be made aware of all possible outcomes which may include, but are not limited to:
- Blood Loss / Transfusion
There is always some blood loss expected. In rare instances, blood loss necessitates a transfusion.
- Drainage of urine from the kidney
In a partial nephrectomy, the collecting system may be opened in the case of a deep tumour. This is repaired during the operation. Despite this, urine may leak out of the kidney and it may be necessary to insert a stent to help overcome this.
- Wound Infection
As with any incision, an infection can occur. This would present with unusual redness, swelling, and/or drainage (white to yellow thick fluid) from in between the sutures. Usually, these are managed with antibiotics and local wound care.
- Wound Bulge
If a partial nephrectomy is performed through an incision in the side, muscles must be divided in order to gain access to the kidney. Whilst these muscles are sutured closed, they may never be quite as strong as before, resulting in a bulge effect. This may vary from a very subtle prominence to a significant bulge. This problem tends to be more common in elderly and overweight patients.
- Deep Vein Thrombosis (DVT) / Pulmonary Embolus (PE)
In any operation (especially longer operations), you can develop a clot in a vein of your leg (DVT). Typically, this presents 2-7 days (or longer) after the procedure as pain, swelling, and tenderness to touch in the lower leg (calf). Your ankle and foot can become swollen. If you notice these signs, you should return to the hospital. Although less likely, this blood clot can move through the veins and block off part of the lung (PE). This would present as shortness of breath and possibly chest pain. We may sometimes ask the medical doctors to be involved with the management of either of these problems.
- Chronic Pain
While unusual, any patient can develop chronic pain in an area that was subject to surgery. The cause is not always forthcoming. While this usually resolves with time, consultation with a pain specialist may be necessary.
Please contact the office within 3 days of discharge. You should make an appointment to see Dr Sved as directed in the hospital. You may see him in his offices at RPA, Bankstown or Strathfield Private Hospital. Do not hesitate to call at any time if you have any concerns. Regular follow-up tests will be required in the long term to monitor kidney function and look for any sign of cancer recurrence.