Nephrectomy

Nephrectomy is a surgical procedure which involves the removal of a diseased kidney. This operation is typically recommended for patients suffering from severe kidney disease, cancer, or other critical conditions that impair the organ's function. Depending on the reason and severity of the condition, a nephrectomy may involve the removal of a part of the kidney, the entire kidney, or both kidneys.

Nephrectomy is considered as a major surgery and is therefore highly recommended to be performed by a specialized Urologist. Over the past few decades, advances in surgical techniques—particularly minimally invasive procedures—have significantly improved patient outcomes and recovery times.

In this article, we explore what nephrectomy involves, why it is performed, the different types of nephrectomy, who performs the surgery, how it is done, and what success rates patients can expect.

The surgical procedure done to remove an affected kidney is called Nephrectomy. It may involve partial removal, known as partial nephrectomy, or total removal, referred to as total nephrectomy. The kidneys are located on either side of the spine, just below the rib cage. Their primary function is to filter waste products, balance fluids and electrolytes, and regulate blood pressure by producing essential hormones. When a kidney is severely damaged or diseased, removing it may be necessary to improve a patient's overall health or prevent the spread of disease.

There are several medical reasons for performing a nephrectomy. Some of the most common include:

• Kidney Cancer: One of the most frequent reasons for nephrectomy is kidney cancer, such as renal cell carcinoma. If the cancer is localized, removing the affected kidney can prevent the disease from spreading.
• Severe Kidney Damage: Chronic kidney infections, traumatic injuries, or congenital abnormalities can cause permanent kidney damage. When the damage is irreversible and the kidney becomes non-functional, nephrectomy may be necessary.
• Kidney Donation: In living-donor kidney transplants, a healthy person donates one of their kidneys to a person with end-stage renal disease. This is a type of elective nephrectomy.
• Obstructive Uropathy: Conditions that obstruct the urinary tract—such as large kidney stones or tumors—can damage the kidney over time. Nephrectomy may be needed if other treatments fail.
• Infections and Abscesses: In rare cases, severe infections that do not respond to antibiotics can lead to the removal of the affected kidney to save the patient’s life.

Nephrectomy is categorized based on the surgical technique used and the extent of removal. The primary types include:

• Radical Nephrectomy: The entire kidney is removed along with the adrenal gland and surrounding fatty tissue. In some cases, nearby lymph nodes are also removed if required. This is typically performed for malignant tumors or large cancers.
• Partial Nephrectomy: Only the diseased or damaged portion of the kidney is removed, sparing the rest of the kidney. Therefore, it is also known as nephron-sparing surgery. This approach is preferred when preserving kidney function is essential.
• Simple Nephrectomy: Only the kidney is removed without disturbing the adrenal gland or surrounding tissues. This is usually performed in cases of benign disease or severe trauma.
• Bilateral Nephrectomy: This involves the removal of both kidneys and is rarely performed unless both organs are severely diseased or cancerous. It is often followed by a kidney transplant.

Nephrectomy is performed by a Urologist—a surgeon who specializes in the urinary tract and male reproductive organs. In cancer cases, a urologic oncologist may be involved, especially if surrounding tissues or lymph nodes are affected. A multidisciplinary team including radiologists, nephrologists, anaesthesiologists, and critical care specialists may also be part of the process to ensure optimal outcomes.

The method of performing a nephrectomy depends on the type of surgery required, the patient’s overall health, and the surgeon’s expertise. There are two main surgical approaches:

• Open Nephrectomy: A large incision (typically 8 to 12 inches) is made on the side of the abdomen or back to access the kidney. This approach is used for complex cases, large tumors, or where cancer has spread.
• Minimally Invasive Nephrectomy: Techniques like laparoscopic or robot-assisted laparoscopic nephrectomy involve smaller incisions and the use of surgical tools and a camera. Benefits include:
  • Smaller incisions
  • Less blood loss
  • Reduced postoperative pain
  • Shorter hospital stays
  • Quicker recovery
  However, patients with obesity, previous abdominal surgeries, or extensive tumor spread may require an open approach.

Recovery depends on the type of surgery and overall health of the patient. In general:

• Hospital stay ranges from 2–7 days.
• Full recovery may take 4–6 weeks for open surgery and 2–3 weeks for laparoscopic surgery.
• Patients should avoid heavy lifting and strenuous activity post-surgery.

Regular follow-ups are essential, especially for cancer patients, to monitor recurrence and assess the function of the remaining kidney.

The success rate of nephrectomy depends on the underlying condition and the patient’s overall health:

• For kidney cancer, the five-year survival rate after a successful nephrectomy for localized tumors is around 90%.
• Partial nephrectomy shows excellent outcomes in preserving kidney function and quality of life.
• Living kidney donors typically live healthy lives with one kidney, with success rates exceeding 98%.
• Minimally invasive nephrectomy has comparable success rates to open surgery, with benefits like faster recovery and fewer complications.

Early diagnosis, meticulous surgical planning, and comprehensive postoperative care are key to successful nephrectomy outcomes.

Nephrectomy is a life-saving procedure used to treat serious kidney conditions such as cancer, trauma, and infections. Thanks to advancements in minimally invasive techniques, patients benefit from quicker recovery and reduced complications. The procedure is performed by specialized urologists and often involves a collaborative approach. With early detection and expert care, the outcomes of nephrectomy are highly successful.

If you or a loved one is facing a nephrectomy, understanding the reasons, types, and recovery expectations can help in making informed decisions and facing the surgery with confidence.