Open Radical Nephrectomy

For large renal tumours where laparaoscopic procedure may be contra-indicated. Bigger invasive procedure and may incur longer hospital stay and prolonged recovery process

Why is it done?

Incidental finding of a solid renal mass larger than 8-10cm suspicious of a renal cancer.

A symptomatic non-functioning kidney with the history of inflammation and abscesses where a large inflammatory process was involved making surgery technically more difficult.

Late symptoms include:

• Hematuria.
• Palpable Mass.
• Flank pain.

Possible crative process for Renal Cell Carcinoma.

Cyto-reductive process prior to or post Tyrokinase Inhibitor (TKI) treatment.

Staging with:

• CT abdomen and chest.
• Bonescan.
• MRI if in Renal Failure or Contrast.
• Allergy.

Chemo-Oncologist will also be involved in your care (not for the non-functioning kidney).

Risk for post-operative dialysis will have been discussed prior to your surgery by means a referral; to a Nephrologist.

How is it done?

• Patients will receive a general anaesthesia, unless contra-indicated.
• Prophylactic anti-biotics is given.
• An indwelling catheter is placed.
• The correct kidney is identified and marked while you are awake.
• A large sub-costal incision is made 2cm under your ribcage stretching from your side to just across the midline of the other side of your abdomen.
• The muscles are cut.
• The colon is reflected to reveal the retro-peritoneal space.
• The ureter is identified and cleared up to the hilum.
• The arteries are identified and tied off and cut first. More than 1 can be present.
• Then the vein/ viens are tied and cut.
• The rest of the kidney is mobilized with its surrounding fat and removed.
• The adrenal gland is also removed in large tumours and upper pole tumours.
• Lymphnodes surrounding the blood supply to the kidney will be removed if the tumour is larger than 4 cm.

What next?

• You will spend up to 5-7 nights in hospital.
• You will have a catheter for that time.
• A drain for 2-3 days.
• You will a trial without the catheter on the 3rd day.
• Renal functions will be checked daily.
• You may enter a phase of poly-uria. High production of urine as the remaining kidney adjusts to the higher work-load.
• You will be discharged as soon as your renal function has stabilised and you can function independently
• Allow for 6 weeks for stabilization of symptoms.
• Restrict fluid intake to less than 3 L per day.
• A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
• A follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporisation.
• Don’t hesitate to ask Jo if you have any queries.
• DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Side–effects

• Minimal to significant blood loss, which may require a blood transfusion.
• Wound Infection.
• Post-operative hernia formations especially associated in the elderly with atrophic abdominal muscles.
• Prolonged hospital stay due to impaired renal function recovery.
• Dialysis as discussed by your Nephrologist, if pre-operatively indicated.
• Post-operative Immunotherapy as prescribed by your Oncologist.
• NB! Each person is unique and for this reason symptoms vary!

Very Important!

The correct side for surgery should be checked:

• CT scan present
• Your approval
• Prior to anaesthesia being commennced.

Download Information Sheet

Nephrectomy Radical Open