Why is nephrectomy needed?
They are two bean-shaped organs located in the abdomen close to the spine. Their function is to filter and purify the blood. The kidney contains small miniature purifiers (nephrons) that filter blood and produces urine.
A kidney may be affected by lesions, cysts, tumors or complete kidney failure. all of these require surgical intervention.
Renal tumorectomy and radical nephrectomy are interventions performed if the patient is suffering from a renal tumor. In renal tumorectomy, the goal is to remove cancer exclusively, saving healthy kidney tissue. On the contrary, nephrectomy consists of removing all the kidney, the fat that surrounds it, and sometimes even the lymph nodes. Removal of the whole kidney is indicated in case of severe kidney impairment, large tumors or when removal of diseased tissue alone is impossible due to localization or anatomy of the kidney.
Surgical Intervention through Nephrectomy – How it happens
The standard surgical treatment for localized or locally advanced kidney cancer (primarily stages T1 to T3, but also stage T4) is the nephrectomy intervention, which consists in the removal of the kidney and of the fat capsule that surrounds it. Usually, the surgeon makes the incision between the ribs that are closest to the tumor. The surgeon may decide to remove some or all of the lymph nodes adjacent to the kidney to check if they contain cancer cells.
It is possible to lead an absolutely healthy life even with a kidney only because the residual organ can perform the function it shared with the sick kidney. However, the removal of a kidney is still a critical intervention, and this is why it must be faced in the best physical conditions.
The possibility of performing this intervention has long been limited by the size of the tumor, which means that the guidelines predicted that tumors with a diameter greater than 4 cm should be treated with nephrectomy. Today, however, even the most massive tumors can be removed saving the kidney as long as it is possible to preserve a part of the renal parenchyma without reducing the efficacy of the procedure.
If the lesion is not extensive, the surgeon can perform a partial nephrectomy, merely removing the tumor and a part of a healthy kidney adjacent to it to ensure complete eradication of the disease.
This intervention is today the standard treatment for lesions less than 7 cm in diameter (stage T1) and can be taken into consideration in all cases where it is essential to preserve the sick kidney, for example, if it is the only one left or if the patient’s kidney function is already reduced before surgery. It can also be implemented if the disease is an inherited form and there is a consequent more significant risk of it spreading to the other kidney. In these situations, partial nephrectomy is a first choice intervention.
- Pulmonary embolism: a blood clot from the veins of the legs may come off and reaches the lungs, giving the patient difficulty in breathing and chest pain. This complication is minimized by having the patient wear special stockings. They “squeeze” the veins of the legs and, by administering anticoagulant drugs, reduce the possibility of blood clots forming in the veins.
- The surviving kidney may have, due to pre-existing illnesses, difficulty in resuming work and producing urine because it is overloaded with work. This condition is called kidney failure. It is treated with drugs that stimulate the kidney to produce urine. However, if the only kidney that remains is not being able to purify the body of the waste, dialysis and a subsequent kidney transplant will be inevitable.
- Blood loss during or immediately after surgery compensated by transfusion.
- Lung infections: are minimized with early mobilization and through the administration of antibiotics.
- If the laparoscopic operation is chosen, intestinal lesions or bleeding from vascular lesions may occur rarely.
India has some of the best urologists and kidney treatment facilities in the world. Fortis Hospital and Kidney Institute in Kolkata and Kokilaben Dhirubhai Ambani Hospital, Mumbai and Apollo Hospitals Bangalore offer the most exceptional laparoscopic surgery and nephrectomy at the cost of INR 1.5 lakhs to 4 lakhs or USD 2,100 to 5,600. Using minimally invasive surgery it is possible to save as much healthy tissue as possible, and India has some of the best surgeons in this field.