Surgery for Kidney Cancer

Most kidney tumors and kidney cancer are cured with surgery. Surgery involves removing the entire tumor in the safest manner for each patient and can be performed through a variety of approaches including a more traditional open incision, laparoscopic surgery or robot-assisted laparoscopic surgery.

Radical Nephrectomy

Radical nephrectomy refers to removal of the entire kidney and the tumor within the kidney. Radical nephrectomy can be performed through an open incision, laparoscopically or with robot-assisted laparoscopic technologies. For larger and more complex tumors, it is frequently associated with removal of the adrenal gland and lymph nodes around the kidney for staging purposes. Radical nephrectomy is usually performed for tumors that are larger and/or those which appear to extend outside the tumor capsule or infiltrate into the kidney. While removal of a kidney can affect overall kidney function, most patients with two healthy kidneys will not develop end-stage renal disease or require dialysis after nephrectomy.

Partial Nephrectomy

Partial nephrectomy is also referred to as nephron-sparing surgery or kidney-sparing surgery. This is usually the preferred approach for smaller tumors in healthy patients. It can be performed for larger tumors in cases where the other kidney may not be healthy and able to function independently. During partial nephrectomy, the surgeon removes the tumor and spares the remainder of the kidney. Partial nephrectomy can be performed through an open incision or robotic-assisted laparoscopic surgery — most partial nephrectomies at Johns Hopkins are performed robotically. Partial nephrectomy offers the benefits of sparing the kidney and saving kidney function; however, it can be associated with higher risks of complications, including bleeding or urine leak.

Surgery for Recurrent Renal Cancer

Some patients may have kidney cancer return after an initial surgery. Experts at Johns Hopkins specialize in surgery for recurrent renal cancer and help patients decide if surgery is the next best approach for the treatment of their cancer. Recurrent renal cancer often involves structures adjacent to the kidney and often requires a multidisciplinary surgical team including vascular, hepatobiliary (liver and pancreas), colorectal, interventional radiologists and thoracic (lung) surgeons to clear a patient of disease. Treatment may involve surgical removal of the recurrences. In some cases, less invasive ablation can be performed for small localized recurrences.

Surgery for Patients with Metastatic Kidney Cancer (Cytoreductive Nephrectomy)

Most cancers that have spread to other organs, including kidney cancer, are best treated with systemic medications and not surgery. For some kidney cancers, however, nephrectomy may improve symptoms, keep patients off medications and offer a better chance at cure. Kidney cancer experts at Johns Hopkins help patients with metastatic kidney cancer decide if and when surgery may help their disease.

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