Radical nephrectomy is a surgical treatment for large renal cell carcinomas (RCC) ². Partial nephrectomies are usually reserved for small / early stage (T1) RCCs and are becoming more common than radical nephrectomies ^11,14, and donor nephrectomies are performed for renal transplants ¹².

Indications

Indications for radical nephrectomy over a partial nephrectomy include tumor staging, renal function, and complexity of surgery ¹¹. Typical indications include:

• stage T3 or T4 RCCs ¹⁰

• RCC in anatomically complex kidneys ¹⁰

• suspicious mass in an atrophic kidney or end-stage renal failure patients ¹¹

• renal trauma not amenable to non-surgical management ¹³

Some authors prefer nephrotomy scoring systems (e.g. RENAL) to assist with procedure selection ^5,11.

Contraindications

Partial nephrectomy is favored over partial nephrectomy in patients with non-complex early-stage tumors with chronic kidney disease or estimated postoperative eGFR <45 ¹¹.

Procedure

Technique

Radical nephrectomies can be performed via open, laparoscopic, or robotic approach ¹⁰. In this procedure, the entire kidney and perinephric fat is removed +/- lymph node dissection +/- adrenalectomy ¹⁰.

Complications

• intra-operative complications: occur in ~17.5% patients ¹⁵

• post-operative complications: occur in ~2% of patients ¹⁵

  • sepsis ¹⁴

  • acute kidney injury ¹⁴

  • pancreatitis ¹⁴

  • retroperitoneal collection secondary to hematoma, urinoma, abscess formation

  • port-site hernia ⁸

Radiographic features

CT/MRI

Non-visualization of the resected kidney in non-complicated cases. The retro-peritoneal fat and adjacent structures may occupy the ipsilateral renal fossa ^3,9,10. RCC recurrence is best seen on arterial phase imaging ¹.