Partial Nephrectomy

What is a partial nephrectomy?

Partial nephrectomy is an operation used to treat cancer of the kidney. During a partial nephrectomy, only the kidney cancer is removed, leaving in place as much healthy kidney tissue as possible.

How is it performed?

The partial nephrectomy can be performed through a single large incision in the abdomen or side (open nephrectomy) or through a series of small incisions in the abdomen (laparoscopic nephrectomy). Robotics assisted laparoscopic surgery are sometimes also used for complex cases. The partial nephrectomy is performed via keyhole surgery where possible, sometimes for larger, more complex cancers, open surgery is required.

Partial nephrectomy involves first clamping the main renal artery. The kidney cancer is then removed with a margin to ensure its complete removal. The kidney defect is then closed with sutures. The renal collecting system and blood vessels are all sutured individually. This is a time critical operation since clamping the renal artery for more than 30 minutes may result in permanent damage to the kidney.

What is the advantage of partial nephrectomy versus total nephrectomy?

The main advantage of partial nephrectomy is in preserving renal function. The kidneys filter the blood and remove waste through making urine. The body cannot adequately survive without adequate renal function. Partial nephrectomy is necessary when the overall kidney function is suboptimal, when there is a single kidney, or when there are multiple kidney cancers in both kidneys. Preservation of renal function have been linked with less risk of suffering from heart disease and longer overall survival.

Unless there is a strong indication, partial nephrectomy is usually only suitable for renal cancers smaller than 4 cm and in a peripheral position.

What are the possible complications?

• Bleeding
• Infection
• Urine leak
• Cancer recurrence
• Conversion to open surgery – 10%
• Conversion to total nephrectomy