Does removing a kidney have any effect on the body? 6 things to know about kidney cancer surgery!

Author: Shi Hongzhe, deputy chief physician, Cancer Hospital, Chinese Academy of Medical Sciences

Reviewer: Li Changling, Chief Physician, Cancer Hospital, Chinese Academy of Medical Sciences

Surgery is often the main treatment for tumors, and kidney cancer is no exception.

Generally speaking, early-stage renal cancer can be treated with kidney-preserving surgery. If the cancer invades the fat around the kidney, radical nephrectomy is required, which means removing the entire kidney and the fat around the kidney.

1. Will it affect the future life of a kidney cancer patient after one side of the kidney is completely removed?

Generally there is no impact.

If the tumor is not large, the kidney should be saved if possible; if the tumor is large, the entire kidney should be removed. The human body is very delicate. After one kidney is removed, the contralateral kidney can actually compensate. As time goes by, the size of the kidney will increase from the image.

Figure 1 Original copyright image, no permission to reprint

Some patients had surgery more than 30 years ago, and the compensatory kidney eventually grew to the size of two kidneys, and the renal function was not affected, so human organs are very delicate. However, there is a rule that the younger the patient, the greater the probability of the contralateral kidney compensating and growing, and the older patients are relatively worse.

2. If you only have one kidney but have kidney cancer or if you have kidney cancer in both kidneys, how should you treat it?

First, anatomically solitary kidney means that the patient has only one kidney. If a tumor grows in an anatomically solitary kidney, the only kidney cannot be removed.

Second, pathologically, although there are two kidneys, one of them is no longer functional. If the tumor grows on the functioning kidney, nephrectomy is not possible.

Third, if there are tumors in both kidneys and the kidney function is not good, and the body functions can barely be maintained, nephrectomy cannot be performed.

What to do? Targeted therapy drugs now have a good effect on shrinking tumors. If the tumor is too large to undergo radical nephrectomy, neoadjuvant targeted therapy can be used to shrink the tumor with some targeted drugs before surgery, so that radical nephrectomy can be turned into a renal tumor resection that preserves the nephron. This can achieve the goal of removing the tumor without removing the kidney.

Figure 2 Original copyright image, no permission to reprint

The principle of bilateral renal cancer is to preserve as many renal units as possible while removing the tumor. Before surgery, the renal function can be tested to predict and evaluate whether the remaining kidney of the patient can maintain body function.

3. What complications may occur after kidney cancer surgery?

Radical renal surgery for kidney cancer means removing the entire kidney. The operation must be performed carefully, the renal blood vessels must be properly handled, and bleeding must be completely stopped. Generally, no complications will occur, but complications may occur if the patient has renal vascular malformations.

Nephron-preserving renal tumor resection requires cutting off a portion of the kidney and repairing the cut part, which is relatively complicated.

Because the kidney is an excretory organ, it filters the blood and discharges some waste into the renal pelvis, which then passes through the renal calyx and renal pelvis and finally enters the bladder to be discharged with urine. If a part of the kidney is removed, the blood vessels and wound surface must be repaired, and if necessary, the renal collecting system must be repaired.

Therefore, after partial nephrectomy, there may be some possibility of urinary incontinence and bleeding. However, with the advancement of current technology, the probability of these complications is not very high.

4. How long will it take to be discharged from the hospital after kidney cancer surgery?

There are currently two methods for kidney cancer surgery: open surgery and minimally invasive surgery.

Open surgery is more direct and is performed by hand. Minimally invasive surgery uses a laparoscope and a robotic arm to insert a camera inside, but the final treatment effect is the same.

For open surgery, patients can usually be discharged from the hospital about a week after surgery. For minimally invasive surgery, patients can be discharged from the hospital in about three or four days due to the small incision.

After discharge from the hospital, you can eat a light diet and lead a normal life, but be careful not to engage in strenuous activities. Because the tissue inside has not yet fully healed, strenuous activities may cause bleeding again.

In addition, since the surgery has just been completed, although the incision has healed, the tissue inside still needs time to heal. At this time, if you use blood-activating drugs, such as aspirin, it may cause the healing surface to bleed again. This is something you need to pay attention to.

5. Will kidney cancer recur or metastasize after surgery?

After radical resection of a kidney tumor, it generally does not recur, but it may metastasize. Because the kidneys are rich in blood, before the tumor is removed, the tumor cells may have already flowed out through the blood.

For locally advanced renal cancer, immunotherapy can be considered after surgery, but there are certain side effects of immunotherapy that need to be noted. If metastasis occurs, targeted therapy or combined targeted and immune therapy is currently advocated or recognized by everyone.

Currently, due to the lack of tumor markers for kidney cancer, the only way to detect tumor recurrence or metastasis is through imaging technologies such as CT scans, MRIs, and PET/CT.

However, the metastasis of kidney cancer is slow, especially for the common clear cell renal carcinoma, which usually occurs one to two years after surgery, but some patients may experience metastasis three to five years or even twenty years after surgery. Therefore, lifelong follow-up examinations are required after kidney cancer surgery.

6. How often should a follow-up examination be conducted after kidney cancer surgery?

Generally, within one year after surgery, the examination should be done every three months. If there is no problem after one year, the examination should be done every six months. After three years, the examination should be done once a year.

The purpose of follow-up examination is mainly to detect recurrence or metastasis at an early stage. The main site of renal cancer metastasis is the lung, followed by the bone, and metastasis can also occur in other sites.

Generally speaking, if a kidney is removed or a nephron is preserved, the follow-up examination should first check the primary site, with ultrasound, CT or MRI. To check for lung metastasis, a chest CT scan should be performed. To check for bone or other metastasis, a bone scan or PET/CT scan should be performed.