Radical Nephrectomy (Kidney Removal) Surgery in Delhi, India

The most common reason why a radical nephrectomy is performed is to remove cancer infiltrated kidneys. However, there could be another kidney disease that can cause damage to this organ. 

Diagnosis of kidney cancer requires a thorough medical history and a physical examination. Doctors will examine the abdomen for any signs of swelling or a lump. In men, doctors may look for an enlarged, twisted vein, or varicocele treatment, in the scrotum.

Diagnostic tests to diagnose kidney cancer are:

1. Urinalysis: A urinalysis will show signs of blood, cancer cells, and other abnormalities in the patient’s urine sample.

2. Complete blood count (CBC): A complete blood count can tell whether the red blood cell count is high, showing polycythaemia. Polycythaemia occurs when the body produces too many red blood cells, causing the blood to thicken and may lead to various issues. Because the kidney produces erythropoietin (a hormone that encourages the formation of RBCs), an increase in RBCs could show a kidney tumour.

3. Blood chemistry tests: Blood chemistry tests can help determine how well the kidneys are functioning. Kidney cancer can impact amounts of certain molecules in the blood, such as liver enzymes and calcium.

4. Ultrasound of the abdomen and kidneys: An abdomen ultrasound can determine the size and form of kidney cancer. Because an ultrasound may miss tiny tumours or kidney stones, another imaging test may be required.

5. Renal CT Angiography: This allows doctors to examine the blood supply to the kidneys in greater detail. The blood supply to a tumour can be visible if one is present.

6. CT scan of the abdomen: A CT scan allows for examination of bones, muscles, fat, organs, and blood vessels. It will help doctors assess the spread of cancer.

 Tests to find out if kidney cancer has spread:

1. MRI

2. Bone scan

3. PET scan

4. Chest CT scan

After all the tests, if the surgeon thinks the best approach is removing the entire kidney, then they will recommend radical nephrectomy. Doctors may decide on a partial or radical nephrectomy based on:

1. Whether the cancer is confined to the kidney

2. Number of tumours

3. The portion of the kidney affected

4. Is cancer infiltrating the nearby tissues?

5. How well the other kidney is functioning?

Radical nephrectomies can be “open”, “laparoscopic”, or “robotic”.

1. Open radical nephrectomy: A single incision or opening is made on the abdomen. This method enables surgeons to do some surgeries that are impossible to execute safely with less invasive techniques. Nowadays, it is only reserved for the large tumour in the treatment of the adjacent structure, venous thrombosis.

2. Laparoscopic Radical Nephrectomy: This procedure is performed through a series of tiny incisions. The surgeon uses a laparoscope to move around the body. It has a tiny camera. When the surgeon is ready to remove the kidney, that tiny incision is expanded. 

3. Robotic Radical Nephrectomy/Robotic Partial Nephrectomy

4. Lymph node removal: If the lymph nodes are enlarged, they may be compromised. If enlarged lymph nodes are detected during surgery, the urologist will decide to remove them.

5. Adrenal Gland Removal: Adrenal gland is crucial for survival. It produces stress hormones. If the tumour has infiltrated the adrenal gland, it will be removed via adrenalectomy. A CT scan can confirm if the tumour has spread to the adrenal gland or not. 

The goal of any treatment or surgery is to remove only the damaged part of the body and leave the rest. The same is true for Radical Nephrectomy. However, partial nephrectomy is not always a viable option. 

A patient is suitable for a radical nephrectomy if:

1. The kidney is severely damaged and cannot function at all. 

2. The other kidney is in optimal condition. 

Nowadays, with the concept of Nephron Sparing Surgery, Partial Nephrectomy is preferred wherever possible.

Older patients between the age of 70 and 80 years are advised to undergo radical nephrectomy because the risk of blood loss during a partial nephrectomy is far greater than the benefit of saving a part of the kidney. But indication varies from person to person.

A person should avoid radical nephrectomy if:

1. There is only one healthy kidney; partial nephrectomy is preferred.

2. A patient Suffers from bleeding disorders such as haemophilia.

3. They suffer from decompensated heart failure or diabetes mellitus(uncontrolled).

4. They are on anti-coagulation medicines.

Before scheduling the surgery, patients should clear all doubts with their surgeon. One should ask questions like:

1. Will I need a radical or partial nephrectomy?

2. Am I a candidate for a laparoscopic procedure?

3. Am I a candidate for a robotic procedure?

4. Are there any other treatment options available?

Patients who have undergone a Radical Prostatectomy usually stay on for three to four days under observation in recovery. This is done to make sure the patient is stable.

Doctors may perform some pre-operative tests to make sure the patient can undergo the procedure with no complications. 

1. Patient is cleared for surgery from different departments, such as cardio, neuro, pulmonary, etc. 

2. Doctors should know about every medication and health supplement taken by the patient. This is crucial if they are on blood-thinning medication and pain relievers such as warfarin and aspirin, respectively. 

Like with any surgery, radical nephrectomy entails the possibility of complications, such as:

1. Bleeding

2. Infection

3. Injury to nearby organs

4. Rarely, other serious problems

5. Post-operative pneumonia

6. Post-operative wounds

7. Infection transmitted via the donated kidney

Long-term effects of a nephrectomy are related to the potential difficulties of living with fewer than two complete, fully functional kidneys. Long-term renal function problems can lead to the following complications:

1. High blood pressure

2. Chronic kidney disease

But with due precautions and regular follow up, one can live a healthy life with a single kidney.

Doctors will inform how soon the patient can leave the hospital depending upon how the surgery went, if any complications arose, and their overall health.

1. The patient will have a urinary catheter in place for a short time during recovery.

2. The patient will receive instructions before leaving the hospital. For example, what to eat, surgical wound care, and signs of infection to look out for.

3. They may be encouraged to resume light activities as soon as they feel ready but must avoid severe exertion or heavy lifting for many weeks.

4. It may take up to six weeks to recover, including the ability to lift and engage in demanding activities.

5. If the patient takes part in a contact sport, they should talk to the doctor about it because it is critical to safeguard the remaining kidney.

Reviewed by Dr. Waheed Zaman, Director - Urology & Renal Transplantation, Urology, Kidney Transplant on 20-May-2022

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