Nephrectomy (Partial and Radical): Types, Recovery and Risks

1What is a nephrectomy?

A nephrectomy is an operation to remove all or part of a kidney. It is most often done for a kidney tumour (see our kidney cancer guide). According to MedlinePlus, it may also be needed for a kidney damaged by infection, kidney stones or other problems, some birth defects, a severe injury that cannot be repaired, or kidney donation.

• Partial (nephron-sparing) nephrectomy: only the tumour and some surrounding tissue are removed and the rest of the kidney is kept.
• Radical nephrectomy: the whole kidney is removed with the fat around it, and sometimes nearby lymph nodes.

2Partial or radical: how the choice is made

The EAU patient information describes partial nephrectomy as the recommended treatment for small (stage 1) kidney tumours when it is technically possible, because keeping healthy kidney tissue helps kidney function over time. According to Cancer Research UK, partial surgery is usually used for cancers 7cm across or less, and also for larger tumours when removing the whole kidney is not possible, for example in people with only one kidney or with poor kidney function. A radical nephrectomy is generally chosen for larger tumours, or when the tumour’s position makes partial surgery unsuitable. The team also weighs your general health and any chronic kidney disease.

3Open, laparoscopic and robot-assisted surgery

Open surgery uses one larger cut in the abdomen or side. In keyhole (laparoscopic) surgery, Cancer Research UK explains that the surgeon makes 3 to 5 small cuts of about 1cm and inflates the abdomen with gas; one cut is made larger to take the kidney out. In robot-assisted keyhole surgery the surgeon controls the instruments from a console with a 3D view. Keyhole methods usually mean less pain, a shorter stay and smaller scars, but take longer and may be switched to open surgery if needed. The EAU notes the choice depends on the tumour and the team’s experience.

🔬Diagnosis and preparation before surgery

A kidney tumour is usually found and assessed with scans. The NHS lists ultrasound, CT scan, cystoscopy and sometimes a needle biopsy, with further scans to check for spread. Not every kidney mass is a tumour; many are simple kidney cysts that need no surgery. Blood tests to measure kidney function help decide how much kidney can safely be removed.

Before the operation you will usually have a pre-assessment with blood tests and heart checks. Tell the team about blood thinners and implants such as pacemakers or stents; the doctor decides which medicines to stop and when.

5The operation, hospital stay and recovery

Nephrectomy is done under general anaesthetic. Afterwards you may have a drip, a bladder catheter and a wound drain, which are removed as you recover; early walking and clot prevention are encouraged. According to Kingston and Richmond NHS, a robotic partial nephrectomy usually takes 3 to 4 hours and most people go home 1 to 3 days later. Cambridge University Hospitals expects a stay of about five to six days after open radical nephrectomy, with skin healing in about 14 days and full recovery taking up to two months.

Kingston and Richmond NHS advises avoiding heavy lifting and strenuous exercise for 3 to 4 weeks and not driving for 2 to 4 weeks, until you can do an emergency stop. Shoulder-tip pain after keyhole surgery comes from the gas and settles within days.

6Possible complications

Your surgeon will discuss the risks that apply to you. Cambridge University Hospitals lists for radical nephrectomy:

• Common (more than 1 in 10): pain at the wound, and bulging of the wound area caused by nerve damage to the abdominal muscles.
• Occasional (between 1 in 10 and 1 in 50): chest infection, bleeding needing a transfusion or further surgery, and wound infection.
• Rare (less than 1 in 50): injury to nearby organs such as the bowel, spleen or liver, and dialysis if the other kidney works poorly.

For robotic partial nephrectomy, Kingston and Richmond NHS reports that switching to open surgery happens in more than 15 in 300 patients, while significant bleeding, needing to remove the whole kidney, and urine leaking inside the body each occur in fewer than 15 in 300.

7Living with one kidney and kidney function follow-up

The National Kidney Foundation says most people with one healthy kidney have few problems, although there is some chance of high blood pressure, protein in the urine or gradual loss of kidney function. It advises having kidney function (eGFR blood test and urine albumin test) and blood pressure checked at least once a year. Ask your doctor before using anti-inflammatory painkillers. After cancer surgery, regular scans and blood tests are also arranged. Read more in living with one kidney.

⏰When to seek urgent care after surgery

Go to the emergency department or contact your surgical team straight away if you have:

• Fever, sweating or shivering, or feel extremely unwell
• Worsening pain in the abdomen or side, or dizziness or fainting
• Repeated vomiting
• Blood in the urine that does not clear with drinking fluids
• Increasing redness, swelling, throbbing or discharge from a wound
• Chest pain or sudden breathlessness (call an ambulance), or a painful swollen leg, which can be signs of a blood clot

❓Frequently asked questions

10Sources

1. Surgery to remove part or all of your kidney – Cancer Research UK
2. Partial nephrectomy (localised kidney cancer) – EAU Patient Information
3. Kidney cancer: Tests and next steps – NHS
4. Radical removal of the kidney: procedure specific information – Cambridge University Hospitals NHS
5. Having part of a kidney removed (robotic partial nephrectomy) – Kingston and Richmond NHS
6. Living with One Kidney – National Kidney Foundation
7. Kidney removal – MedlinePlus Medical Encyclopedia