Radical Nephrectomy (Total Kidney Removal)

RADICAL nephrectomy: how it’s performed (2011-2015):

Partials vs. Radicals Nephrectomies

During radical nephrectomy, the entire kidney and surrounding fat are completely removed.  The surgeon may also remove the adrenal gland and neighboring lymph nodes.  Radical nephrectomy is typically reserved for patient with large, advanced or metastatic renal cancers.  However, some patient with small renal masses are not eligible for a partial nephrectomy and radical nephrectomy is the treatment of choice.

We advise a thorough evaluation by a team of kidney cancer and kidney surgery experts to determine whether this is the best option for you.

How is a radical nephrectomy performed?

During a radical nephrectomy, the kidney is detached from its blood supply and removed from body.  Radical nephrectomy can be performed through an open incision, laparoscopically or with robotic technology.  Open radical nephrectomy is typically performed through an incision, typically large enough for the surgeon to work and safely remove the kidney.  If performed laparoscopically or robotically, the kidney is disconnected from the body using a few tiny incisions. It is then placed in a sealed bag and extracted from the body from a larger incision in a more comfortable area to recover from than an open nephrectomy.

If I need a radical (total) nephrectomy, can I still have it done laparoscopically?

The vast majority of kidney removals we perform are done via a minimally invasive method (laparoscopically or robotically).  In fact, Johns Hopkins urologists have been performing these techniques longer than most institutions and several key studies documenting the safety and efficacy of laparoscopic nephrectomy are from Johns Hopkins. 

Initially these minimally invasive techniques were reserved for patients with relatively small tumors.  However, Johns Hopkins urologists have demonstrated laparoscopic and robotic surgery to be safe and feasible in large tumors and tumors invading the large renal vein or inferior vena cava.  However, laparoscopic or robotic radical nephrectomy is not safe for all patients and all tumors.  The kidney cancer experts at Johns Hopkins will help you determine which approach is best for you.

How is an open nephrectomy performed?

This procedure involves making an incision to remove the kidney.  The incision is typically made in the flank, over the ribs.  However a multitude of other incisions can be utilized including incisions than run beneath the ribs, along the midline (vertical), or intentionally opening the chest cavity (thoracoabdominal incision) to gain better working space near the kidney.

Your surgeon will select the most optimal incision depending on patient and tumor specific factors.

Is the adrenal gland removed?

Traditionally the adrenal gland was always removed with the kidney and its surrounding, protective fatty layer.  Imaging has improved and the adrenal gland is only removed if it appears to be involved by cancer.  If one of your adrenal glands needs to be removed, the remaining adrenal gland should provide all the adrenal hormones and functions you would need.

Are the lymph nodes routinely removed during a nephrectomy procedure?

The short answer is, No.  Lymph nodes are typically inspected but not always removed.  Your kidney cancer expert will help determine if you should undergo a lymph node dissection and what the extent of that lymph node dissection should be.  Patients with enlarged lymph nodes on preoperative imaging or found in the operating room may have them removed.  Reasons not to perform a lymph node dissection include increased time of the operation and risk of complications, the fact that many enlarged lymph nodes are enlarged due to inflammation and not kidney cancer, and a large study that did not demonstrate a survival benefit to lymph node dissection in patients with kidney cancer.  The surgeons at Johns Hopkins are experts in kidney cancer and retroperitoneal lymph node dissection done through both open and minimally invasive approaches to the kidney.  They will help you decide if a lymph node dissection is in your best interests.