What is a partial nephrectomy?
A partial nephrectomy is a surgery in which only part of the kidney is removed, as opposed to a radical nephrectomy, in which the entire kidney is removed. The surgeon removes only the part of the kidney with the kidney tumor and a small area of healthy kidney surrounding the tumor, which is called a negative margin. The goal of doing a partial nephrectomy is to leave as much of the healthy kidney intact as possible. The surgical removal of kidney tumors (also called renal tumors) is a standard treatment for kidney cancer. The type of surgery and amount of kidney that is removed depends on the type and size of the tumor and extent of the cancer.
Why a partial nephrectomy and not a radical nephrectomy?
Your child’s surgeon will perform a partial nephrectomy when possible to keep as much kidney function as possible. We perform a partial nephrectomy when children have tumors in both kidneys or have a tumor in their only kidney and cannot afford to have all of their kidney function removed. Also, in children who have conditions that increase their risk of kidney tumors, we attempt to treat them with a partial nephrectomy to ensure they retain as much of the functional kidney as possible.
What happens before the surgery?
If your child’s doctor recommends a partial nephrectomy, you will probably have lots of questions and concerns. Getting answers to these questions can help relieve or reduce any anxiety you or your child may have so you can focus on healing and fighting your child’s cancer.
If your child is scheduled for a partial nephrectomy, they will be admitted to the hospital on the day of surgery. Your family can wait in the surgical waiting area on the second floor while your child is in surgery. After the surgery is complete, the surgeon will contact your family there. Your child’s doctor will give you specific instructions for how to prepare for this particular surgery, but you can also find general information about preparing for surgery on our website.
What to expect during a partial nephrectomy
Our surgeons can perform a partial nephrectomy using open surgery or laparoscopy. In either case, a pediatric anesthesiologist will administer anesthesia, so your child will be asleep during the surgery. For an open surgery, your child’s surgeon will make an incision (a cut) in the abdomen and remove the kidney tumor. The surgeon makes the incision across the side or in the front, just below the rib cage. This allows them to thoroughly examine the kidney and the surrounding tissue for any possible tumor spread. To completely remove the cancer, the surgeon will remove the kidney tumor and the lymph nodes around the kidney. It usually takes a few hours to perform this operation.
Laparoscopic partial nephrectomy is a minimally invasive surgical procedure that is generally used for a very specific group of smaller, localized renal tumors, or tumors that are located on the outer edge of the kidney. This procedure is performed by making several small "key-hole" incisions in the abdominal cavity. The surgeon inserts a tiny camera, or laparoscope, through the incision and uses specialized surgical instruments to perform the surgery and remove the kidney tumor. Then, the surgeon expands one of those small incisions to a somewhat larger incision to allow for easy removal of the kidney tumor. The benefits of this type of surgery usually include a shorter hospital stay, faster recovery and less pain afterwards.
The Solid Tumor Program at Children’s Hospital Colorado consists of pediatric surgeons, pediatric urologists and pediatric oncologists who will often combine surgical methods with chemotherapy when treating most pediatric kidney cancers. Because of our collaborative approach, we can offer different treatment options and tailor the treatment to each individual patient.
What to expect after a partial nephrectomy
After the operation, your child is taken to the recovery room until they wake up and vital signs (blood pressure, pulse and respiration) are stable. We’ll relieve any pain or discomfort with medication, and your child will typically stay at the hospital for 3 to 5 days to recover from an open surgery and 1 to 2 days to recover from minimally invasive surgery.
Patients will have a dressing they need to wear for several days and many will have a small drain that comes out of the skin below the incision. This collects the fluid from around the healing kidney. Your surgeon may also place a small tube inside, called a ureteral stent, that goes from the bladder to the kidney. This promotes the urine to flow down the normal way, from the kidney through the ureter to the bladder, as opposed to draining out of the kidney where the tumor was resected. Both the drain and stent are temporary and will be removed after recovery. Most patients will not have a bowel movement for several days after surgery so we will give them stool softeners and laxatives.
After leaving the hospital, your child should have a diet that incorporates a lot of fiber and fluids to help with constipation. Patients taking any narcotic pain medication must be particularly careful to avoid constipation. Milk of Magnesia is a gentle laxative that helps, as well as Metamucil or any bulk laxative taken every day will help to regulate your child’s bowel movements and are an excellent way of preventing constipation. It usually takes about four weeks for the surgical area to heal completely and your child should not do any heavy lifting or exertion exercises during this time. The length of time each patient takes to recover varies depending on the patient. Your doctor will monitor your child’s recovery and discuss the timeline of returning to activity depending on their progress.
A partial nephrectomy can be hard to adjust to and we can provide support to help patients and families cope with the impact it may have in your lives. Our social workers help care for patients and their families while at the hospital and can provide names and numbers of support groups after your child leaves the hospital.
Call the ParentSmart Healthline with any questions or concerns at 1-855-543-4636 (KID-INFO).
Why choose us for a partial nephrectomy
Our Solid Tumor Program team is nationally known for the amazing work they do and some of our doctors are even specialized in pediatric urologic oncology and surgical oncology, which is quite rare to find. Their expertise, along with the support they receive from their talented teams has helped Children’s Colorado excel in the surgical treatment of pediatric renal tumors.
We also have other teams and support staff that are trained in preparing children for surgery, both physically and mentally. Our Child Life team explains the operation in a way children can understand, which helps to ease their anxiety. Our child life specialists can also support children during medical tests prior to the surgery. Our pediatric anesthesiologists are also specifically trained to work with kids, so they know the right amount of anesthetic to give and understand how children react differently to medications than adults.
A surgery like this is never fun, but we’ve designed a place that makes it as easy as possible on children and their family. Our kid-friendly space combined with our pediatric-trained doctors make it the best choice in the Rocky Mountain region for a surgery like a partial nephrectomy.