For Patients
Kidney Cancer
Background
Most solid tumours in the kidney are malignant (cancerous) and are more common in men. They can produce blood in the urine and pain in the side, but can grow to a large size without the patient being aware. A doctor may be able to feel the enlarged kidney. A tumour of the kidney can produce vague symptoms, loss of appetite and weight and unexplained tiredness.
Treatment and Management
An ultrasound scan or CT will often have been done to make the original diagnosis. Removal of the whole kidney containing the tumour is often advised although smaller tumours can be removed without the need to remove the whole kidney. Your general health will not be affected by the removal of one kidney, provided the other is normal. This is ensured before surgery is planned. The operation to remove part of, or the whole kidney, is generally performed by means of keyhole (laparoscopic or robotic) surgery.
Robotic partial removal of the kidney (partial nephrectomy)
What does the procedure involve?
This involves removal of part of the kidney with the surrounding fat for suspected cancer of the kidney, through several keyhole incisions. It involves the placement of a telescope and operating instruments into your abdominal cavity using 3-5 small incisions. One incision will need to be enlarged to remove the kidney
What are the alternatives to this procedure?
Observation, total nephrectomy, and open surgery
What should I expect before the procedure?
You will usually be admitted on the same day as your surgery. You will normally receive an appointment for pre-assessment before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which will include the Consultant and Specialist Registrar, and your named nurse.You will need to wear anti-thrombosis stockings during your hospital stay; these help prevent blood clots forming in the veins of your legs during and after surgery.
What happens during the procedure?
Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. A bladder catheter is normally inserted during the operation to monitor urine output and a drainage tube is usually placed through the skin into the bed of the kidney.
What happens immediately after the procedure?
You will be given fluids to drink from an early stage after the operation and you will be encouraged to mobilise early to prevent blood clots in the veins of your legs. The wound drain will need to remain in place for up to 1 week in case urine leaks from the cut surface of the kidney. The average hospital stay is 4 days.
Are there any side-effects?
Most procedures have a potential for side-effects. You should be reassured that, although complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.
Up to 10% patients will develop a urinary leak from the cut edge of the kidney which will require further treatment, usually with insertion of a ureteric stent. Some patients develop bleeding and may require a blood transfusion. In some cases a procedure (called embolisation) in the X-ray department may be required to stop any bleeding. Sometimes, the histological abnormality (as checked under a microscope) may eventually turn out not to be cancer.
What should I expect when I get home?
Before you leave hospital, the team will ensure you are safe to be discharged home. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
There may be some discomfort from the small incisions in your abdomen but this can normally be controlled with simple painkillers. All the wounds are closed with absorbable stitches which do not require removal. It will take at least 14 days to recover fully from the procedure and most people can return to normal activities after 2-6 weeks. If a ureteric stent has been inserted, you may notice that you pass urine more frequently with pain in the bladder region.
What else should I look out for?
If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, increasing abdominal pain or dizziness, please contact your GP immediately. Any other post-operative problems should also be reported to your GP, especially if they involve chest symptoms.
Are there any other important points?
A follow-up outpatient appointment will normally be arranged for you 6-12 weeks after the operation. At this time, we will be able to inform you of the results of pathology tests on the removed section of the kidney. It will be at least 14-21 days before the pathology results on your kidney are available. It is normal practice for the results of all biopsies to be discussed in detail at a multi-disciplinary meeting before any further treatment decisions are made. You and your GP will be informed of the results after this discussion. If a ureteric stent has been inserted, arrangements will be made for its removal approximately 6 weeks after your discharge from hospital.
Laparoscopic radical removal of the kidney (total nephrectomy)
What does the procedure involve?
This involves removal of the kidney for suspected cancer of the kidney through several keyhole incisions. It requires the placement of a telescope and operating instruments into your abdominal cavity using 4-5 small incisions. The adrenal gland may also be removed and one incision will need to be enlarged to remove the kidney
What are the alternatives to this procedure?
Observation, open surgery
What is laparoscopic surgery?
Laparoscopy (otherwise known as “keyhole surgery”) is a form of minimal access surgery. This involves performing operations which are traditionally done by an “open” method but using “keyholes” instead. A number of urological procedures are now being performed by this method. It has been shown to be safe and effective for kidney surgery and is the preferred surgical method for the removal of a kidney.
Your urologist will discuss the details of the procedure with you whilst you are an outpatient, outlining the procedure as part of your consent. You should be aware that there is a small chance (less than 1%) that your procedure may need to be converted to an open procedure. For this reason, if you are insistent that you would not agree to an open operation under any circumstances, we would not be able to proceed with the laparoscopic operation.
What should I expect before the procedure?
You will usually be admitted on the same day as your surgery. Unless done on the same day as your urology clinic appointment, you will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the surgical team which will include the Consultant, Specialist Registrar, and your named nurse.
You will need to wear anti-thrombosis stockings during your hospital stay; these help prevent blood clots forming in the veins of your legs during and after surgery.
What happens during the procedure?
A full general anaesthetic will be used and you will be asleep throughout the procedure. You will be transferred to the operating theatre on your bed and you will be taken first to the anaesthetic room. They may put a drip in to your arm to allow them to access your circulation during the operation. You will be anaesthetised and taken into the operating theatre. The kidney is disconnected through several keyhole incisions and put into a bag which is then removed by extending one of the keyhole incisions.
A bladder catheter is normally inserted during the operation to monitor urine output and rarely, a drainage tube may be placed through the skin into the bed of the kidney.
What happens immediately after the procedure?
It is fine, and in fact you will be encouraged, to eat and drink as soon as you feel able to after surgery. You will be encouraged to mobilise as soon as possible after surgery. This helps to prevent blood clots forming in your legs, a chest infection from developing, and also decreases any disturbance to your bowel function. The catheter is normally removed on the morning after surgery. The expected hospital stay is 2 to 3 days.
Are there any side-effects?
Most procedures have a potential for side-effects. You should be reassured that, although complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.
There is a small risk of bleeding with surgery, and you may require a blood transfusion. Rarely, bleeding during the operation may necessitate conversion to open surgery (involving a larger cut in the skin). Sometimes, the histological abnormality (as checked under a microscope) may eventually turn out not to be cancer.
What should I expect when I get home?
Before you leave hospital, the team will ensure you are safe to be discharged home. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
There may be some discomfort from the small incisions in your abdomen but this can normally be controlled with simple painkillers. All the wounds are closed with absorbable stitches which do not require removal. It will take at least 14 days to recover fully from the procedure and most people can return to normal activities after 2-6 weeks.
What else should I look out for?
If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, increasing abdominal pain or dizziness, please contact your GP immediately.
Are there any other important points?
A follow-up outpatient appointment will normally be arranged for you around 6 weeks after the operation. At this time, we will be able to inform you of the results of pathology tests on the removed kidney. It will be at least 14-21 days before the pathology results on the tissue removed are available. It is normal practice for the results of all biopsies to be discussed in detail at a multi-disciplinary meeting before any further treatment decisions are made. You and your GP will be informed of the results after this discussion.
If a cancerous growth is found in the removed kidney, you will be closely followed in clinic with blood tests every 6 months, and chest x-rays and scans less frequently.
After removal of one kidney, there is no need for any dietary or fluid restrictions since your remaining kidney can handle fluids and waste products with no difficulty.
Open radical removal of the kidney (total nephrectomy)
What does the procedure involve?
This involves removal of the kidney, adrenal, surrounding fat and lymph nodes for suspected cancer of the kidney, using an incision either in the abdomen or in the side/flank.
What are the alternatives to this procedure?
Observation alone, partial nephrectomy and laparoscopic (telescopic or minimally-invasive) nephrectomy.
What should I expect before the procedure?
You will usually be admitted the day of your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the surgical team which will include the Consultant, Specialist Registrar, and your named nurse.
What happens during the procedure?
A full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. The kidney is usually removed through an incision in your abdomen although, on occasions, the incision is made in the side (loin) or extended into the chest area. A bladder catheter is normally inserted post-operatively, to monitor urine output, and a drainage tube is sometimes placed through the skin to lie where the kidney was removed from.
What happens immediately after the procedure?
After the operation, you may remain in the Special Recovery area of the operating theatres before returning to the ward; visiting times in these areas are flexible and will depend on when you return from the operating theatre. You will normally have a drip in your arm and, occasionally, a further drip into a larger vein in your neck.
You will be able to drink clear fluids immediately after your operation and start a light diet within 1-3 days. We will encourage you to mobilise as early as possible and to take fluids or food as soon as you are able. We would expect your hospital stay to be about 5-7 days but some people do go home sooner or may need to stay slightly longer.
Are there any side-effects?
Most procedures have a potential for side-effects. You should be reassured that, although complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.
There is a small risk of bleeding with surgery, and you may require a blood transfusion. Sometimes, the histological abnormality (as checked under a microscope) may eventually turn out not to be cancer.
What should I expect when I get home?
When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
It will be at least 14 days before healing of the skin wound occurs but it may take up to 3 months before you feel fully recovered from the surgery. You may return to work when you are comfortable enough and your GP is satisfied with your progress. It is advisable that you continue to wear your elasticated stockings for 14 days after you are discharged from hospital. Many patients have persistent twinges of discomfort in the loin wound which can go on for several months.
After surgery through the loin, the wall of the abdomen around the scar will bulge due to nerve damage. This is not a hernia but can be helped by strengthening up the muscles of the abdominal wall by exercises.
What else should I look out for?
If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your GP. Any other post-operative problems should also be reported to your GP, especially if they involve chest symptoms.
Are there any other important points?
It will be at least 14-21 days before the pathology results on your kidney are available. It is normal practice for the results of all biopsies to be discussed in detail at a multi-disciplinary meeting before any further treatment decisions are made. You and your GP will be informed of the results after this discussion.
An outpatient appointment will be made for you 6 weeks after the operation when we will be able to inform you of the pathology results and give you a plan for follow-up.
Once the results have been discussed, it may be necessary for further treatment but this will be discussed with you by your Consultant or Specialist Nurse. After removal of one kidney, there is no need for any dietary or fluid restrictions since your remaining kidney can handle fluids and waste products with no difficulty.