Overview
When the kidney is taken to take the tumor.
In our practice, nephrectomy is almost always performed as part of an en-bloc multivisceral resection for adjacent disease — most commonly retroperitoneal sarcoma, locally advanced colorectal cancer with renal involvement, locally advanced pancreatic or duodenal cancer, and adrenal cancer extending into the kidney. The goal is to remove the main tumor with negative margins, and that sometimes requires taking the kidney with the specimen rather than dissecting along a plane that risks tumor disruption.
This is different from a radical or partial nephrectomy for primary kidney cancer, which is typically a urologic operation. We coordinate with urology when the planning crosses specialties — for example, when the case involves both an oncologic en-bloc resection (general/oncologic surgery) and a renal vein or caval thrombus management (urology and sometimes vascular surgery). Pre-op planning is multidisciplinary: imaging review, renal function assessment, and a clear operative plan agreed upon by everyone involved.
Who is a candidate?
Patients with retroperitoneal sarcoma involving or abutting the kidney, with locally advanced colorectal or pancreatic cancer with renal involvement, or with adrenal cancer extending into the kidney, are the typical candidates for nephrectomy in our practice. Patients with primary kidney cancer (renal cell carcinoma) are best served by a urologic oncologist and we refer accordingly. Patients with severe renal trauma where the kidney is not salvageable can need acute nephrectomy as part of damage control. The decision is always made in a multidisciplinary setting with imaging review and clear discussion of the goals of the operation.
How we perform it
Under general anesthesia, position depends on the operation — most en-bloc retroperitoneal resections are done supine through a midline incision, occasionally with a thoracoabdominal extension for very large upper-quadrant tumors. We expose the retroperitoneum, identify the renal artery and vein at the great vessels, and control them with vascular clamps or staplers. The renal artery is divided first to avoid venous congestion. The ureter is identified, dissected to a safe length, and divided. The kidney is then mobilized en-bloc with the main tumor specimen along oncologic planes — meaning we do not enter the tumor and we preserve all margins. We routinely identify and protect the opposite ureter and great vessels. Total operative time is highly variable depending on the main resection — 3 to 8 hours is common for retroperitoneal sarcoma.
Recovery
Hospital stay is 5–10 days for most multivisceral resections that include a nephrectomy — driven by the main resection, not by the kidney removal itself. We monitor renal function closely in the early post-op period and at every follow-up visit. Pain is controlled with a multimodal regimen. Diet advances as bowel function returns when intestinal resection was part of the case. Walking starts the day of surgery. We see you in clinic at 2 weeks and 6 weeks. Long-term kidney function is usually preserved when the opposite kidney is healthy at baseline. Oncologic surveillance is determined by the main diagnosis.
Why Florida Surgical
Multivisceral resections demand judgment, planning, and a willingness to coordinate across specialties. Both Dr. Shaw and Dr. Decio are fellowship-trained surgical oncologists who plan and execute en-bloc operations including nephrectomy when needed, in close coordination with urology, vascular surgery, and medical/radiation oncology. We are honest about when a case is best handled by a urologic oncologist alone (primary RCC) and when a multidisciplinary team is needed (retroperitoneal sarcoma, locally advanced abdominal cancer with renal involvement).
Frequently asked questions
Why is a general/oncologic surgeon doing a nephrectomy?
Nephrectomy for primary kidney cancer (renal cell carcinoma) is typically done by urologists. Nephrectomy performed by a surgical oncologist or general surgeon is almost always for non-kidney pathology where the kidney must come out en-bloc with the main tumor: retroperitoneal sarcoma invading the kidney, locally advanced colorectal or pancreatic cancer with renal involvement, adrenal cancer extending into the kidney, or severe trauma. We coordinate with urology when the case crosses specialties.
Can I live with one kidney?
Yes — most patients live a normal life with one kidney as long as the remaining kidney has reasonable function. We measure baseline kidney function before surgery (GFR) and predict post-op function based on the contribution of the kidney being removed. If the remaining kidney is reasonably healthy, you should not need dialysis. We avoid drugs that injure kidneys (NSAIDs, certain antibiotics, contrast dye when avoidable) and monitor function for the rest of your life.
Will my recovery be longer because of the nephrectomy?
Removing a kidney does not by itself add much to recovery — the kidney is taken with the rest of the en-bloc specimen and the operative time, blood loss, and recovery profile are driven by the overall operation rather than the kidney alone. The bigger drivers of recovery are the main resection (bowel, pancreas, sarcoma resection) and the patient's baseline reserve.
What are the risks specific to nephrectomy?
Beyond the risks of any major abdominal operation, nephrectomy-specific risks include kidney function decline, the rare need for dialysis if the remaining kidney is also compromised, hemorrhage from the renal vessels at the time of division, and ureteral injury on the opposite side (we identify and protect both ureters during the case). When the kidney is removed for retroperitoneal sarcoma or other adjacent disease, the risk picture is dominated by the main resection.
Will I need to see a kidney doctor after surgery?
We monitor kidney function after surgery and at every follow-up visit. If your remaining kidney function is normal or near-normal, no specialist is needed beyond our follow-up and your primary care physician. If function is reduced, or if you have other risk factors (diabetes, hypertension), we refer you to a nephrologist. We always send referrals when there is any concern.