• The preferred treatment for renal cell carcinoma
• The choice of surgical procedure depends on the extent of the disease, as well as patient-specific factors such as age & comorbidity
• May be carried out through a conventional approach or by a minimally-invasive approach

Partial Nephrectomy or Nephron-Sparing Surgery (NSS)

• Indicated in patients w/ solitary kidney, one kidney w/ contralateral renal function & bilateral synchronousrenal cell carcinoma (RCC)
• Used for patients w/ small unilateral tumors
• Only the diseased or injured portion of the kidney is removed
• Contraindicated in patients w/ confirmed nodal metastases

Radical Nephrectomy

• The most widely used approach & the preferred procedure if there is evidence of invasion into the adrenal gland,renal vein or perinephric fat
• Involves the removal of the entire kidney along w/ a section of the tube leading to the bladder, ureter, adrenalgland & fatty tissues surrounding the kidney

Other Procedures

Adrenalectomy

• Considered in patients w/ large upper pole tumors or abnormal-appearing adrenal glands on
• Computed tomography (CT) scan & must be decided on an individual basis

Cryoablation

• Indicated for <3 cm solitary renal tumor located away from the collecting system

Cytoreductive or Debulking Nephrectomy

• Mostly involves the removal of the primary tumor from the kidney
• Recommended in patients w/ good performance preceding systemic therapy

Radiofrequency Ablation

• An alternative treatment in patients w/ contraindications to nephrectomy, Von Hippel-Lindau disease & unfit elderly patients
• Creates molecular friction, denaturation of cellular proteins & cell membrane disintegration
• Heat-based tissue destruction w/ a high-frequency electrical current (400 to 500 kHz)

Metastasectomy

• The lungs, bones, brain & liver are the most common sites of metastasis
• Done in conjunction w/ radical nephrectomy but may also be performed following a relapse after surgery

Risks & side effects of surgery

• Short-term risks includes reactions to anesthesia, excess bleeding (may require blood transfusions), blood clots & infections
• Damage to internal organs & blood vessels (spleen, pancreas, aorta, vena cava, large or small bowel) during surgery
• Leakage of urine into the abdomen (after partial nephrectomy)
• Kidney failure (if the remaining kidney fails to function well)