Radical Nephrectomy
This is a procedure carried out in an effort to cure kidney cancer. The entire kidney is removed as opposed to a partial nephrectomy.
The procedure itself is performed through a flank incision based on either the 11th or 12th rib. Occasionally, if the tumour is very large an incision is made through the chest cavity. The kidney is mobilised and the blood vessels and ureter are ligated prior to its removal. The wound is then closed with absorbable sutures. A drain is not usually required.
The operation takes around 2 hours and the usual hospital stay is about 5 days. A urinary catheter is usually required for the first few days and this will be put in when you are asleep.
Intraoperative complications:
The main potential intraoperative complication is the risk of significant blood loss requiring a blood transfusion. The average blood loss of this procedure over the last 10 years is around 500 ml and it is very rare (<1%), to have to transfuse anyone. Having said that, if you need it you will get it!
The kidney sits high up underneath the rib cage and it is quite common to enter the chest cavity when approaching the kidney. The chest cavity is closed and there are usually no consequences of this. Very occasionally a patient will need a drain from the chest cavity for 2 or 3 days.
The kidney sits very close to other organs which include the spleen, pancreas and large bowel on the left-hand side and the duodenum on the right. It is very rare to have injuries to these organs but this is always a possibility particularly if the tumour is very large.
Post-operative complications:
The main risks following this procedure relate to the wound and are due to the particular anatomy of the nerves that supply the flank muscles.
Flank bulge
A number of patients will experience a bulge in the flank at the site of the wound. This occurs because the nerves that supply the flank muscles (intercostal nerves), run straight across the wound and need to be divided in order to allow access to the kidney. If only one of these nerves run across the wound then there is usually no issue, if there are 2 then it is not usually a problem but if there are 3 most people will develop a bulge. This is usually not uncomfortable but can look a little asymmetrical. It is not a hernia. If it is a problem sometimes a mesh repair may be required.
Numbness
Because sensory nerves are cut many patients develop an area of numbness below the wound. Often this gradually decreases in size with time and in most patients it is not an issue.
Neuroma
In a minority of patients the cut the ends of the intercostal nerves sprout abnormal fibres during the healing phase. This is called a neuroma. Whilst this is rare it can be very uncomfortable and treatment may be difficult.
Renal function
If you have a normal kidney on the other side there is usually no consequence to removing a kidney. About one in 1000 people are born with only one kidney and lead perfectly normal lives, often not even knowing that they have only a single kidney.
Your further follow-up and screening from the cancer point of view will be personalised and we will discuss this with you at your follow-up appointment.
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