Nephrectomy: Surgical removal of a kidney

Types and techniques

Surgeons distinguish among several approaches depending on the disease and patient factors. A radical nephrectomy removes the entire kidney and often surrounding fat, and sometimes the adrenal gland and nearby lymph nodes. A partial nephrectomy (nephron-sparing surgery) removes only the tumor-bearing portion, preserving as much kidney tissue as possible. Approaches include open surgery, laparoscopic (minimally invasive) techniques, and robot-assisted laparoscopy.

Indications and decision factors

Choice of procedure depends on tumor size and location, kidney function, patient comorbidities, and oncologic considerations. When feasible, partial nephrectomy is favored to maintain long-term renal function. In cases of large or centrally located tumors, or when cancer has spread within the kidney, radical nephrectomy may be recommended.

Procedure and recovery

Preoperative preparation includes imaging, laboratory testing, and assessment of overall fitness. Minimally invasive techniques typically involve smaller incisions and shorter hospital stays than open procedures. Recovery focuses on pain control, gradual return to activity, and monitoring of kidney function. Patients with one remaining kidney generally maintain adequate function but require follow-up to detect hypertension or chronic kidney disease.

Risks, outcomes and follow-up

• Common risks: bleeding, infection, and injury to adjacent organs.
• Long-term concerns: reduced renal function and increased cardiovascular risk if overall kidney reserve is diminished.
• Oncologic outcomes vary by tumor stage; nephrectomy can be curative for localized cancers.

History and notable developments

Nephrectomy has evolved from open surgery to minimally invasive and robotic-assisted techniques over the late 20th and early 21st centuries. These advances reduced surgical trauma and improved recovery times while expanding the use of nephron-sparing surgery for suitable tumors.

Careful postoperative surveillance and collaboration between urologists, nephrologists, and primary care providers are important to preserve kidney health and to monitor for cancer recurrence when nephrectomy is performed for malignancy.