Partial Nephrectomy/Nephron-Sparing Surgery

Partial nephrectomy (neh-FRECK-tum-ee) is a procedure that removes the part of a kidney that contains a small- to medium-sized tumor, while preserving some or all of the normal part of the kidney. It is also called nephron-sparing surgery

In addition to kidney tumors such as Wilms tumors and renal cell carcinomas, this procedure may be needed to treat:

• Birth defects.
• Damage from kidney stones.
• Kidney infections.
• Traumatic injury to the kidneys.
• Other conditions in which tumors grow on the kidneys or damage the kidneys.

Partial nephrectomy surgery removes the infected part of the kidney while preserving as much healthy kidney tissue as possible.

Kidneys are vital organs — they are the body's filtration system. Having two working kidneys helps the body remove toxins, create urine, and balance electrolytes in the body.

This procedure involves removing the tumor on the kidney and a small amount of surrounding healthy tissue cells to make sure the cancer is completely removed and to reduce the risk of it coming back.

Partial nephrectomy vs. radical nephrectomy

Partial nephrectomy is focused on removing only part of the infected kidney and keeping the healthy part of the organ. Radical nephrectomy completely removes the affected kidney and, sometimes, the surrounding lymph nodes or tissues.

If the tumor has grown too large to preserve some of the kidney, or if cancer has spread beyond the kidney, doctors may recommend a full kidney removal surgery over a partial removal.

Partial nephrectomies typically will be performed on tumors smaller than three inches. However, the decision depends on many factors, including:

• Number of tumors.
• Stage of cancer.
• Tumor location.
• Tumor size.
• Your child’s overall health.

What are the types of partial nephrectomy?

There are two methods of performing partial nephrectomy or nephron-sparing surgery: open and minimally invasive. Depending on the size of the tumor or the amount of kidney damage, you may not be able to choose which method is performed.

Here’s what you need to know about them both:

Open partial nephrectomy

Open partial nephrectomy is the more traditional approach to surgery. This method involves larger incisions that open the abdomen for the surgeon to directly access the kidney. The surgeon uses tools to remove the infected part of the kidney and reconstruct the healthy parts before closing the incision with stitches or staples.

If the tumor is too large to be removed in a minimally invasive procedure, an open procedure will be used.

The open surgical method is highly effective but may require a longer hospital stay and recovery.

Minimally invasive partial nephrectomy

Minimally invasive partial nephrectomy is a standard of care choice for small- and medium-sized tumors. It involves multiple small incisions around the abdomen through which small, narrow instruments are inserted to perform minimally invasive surgery.

This laparoscopic (lap-uh-row-SKOPP-ick) surgery provides a high level of precision for the surgeon. It can help preserve more healthy kidney tissue.

If this method is an option for your child, it is considered highly effective. It has additional benefits, including:

• Fewer complications after surgery.
• Milder and more manageable pain after surgery.
• Reduced hospital stay length.
• Reduced recovery time.
• Reduced scarring.

Is partial nephrectomy right for my child?

Your child’s care team will talk with you about a partial nephrectomy if they believe the affected part of their kidney can be removed while keeping some healthy kidney tissue in place.

The long-term outlook for children with partial nephrectomy is generally positive. However, your doctor will discuss the prognosis depending on your child’s health, type and stage of cancer, and the success rate from surgery.

Before surgery

Before surgery, your child may undergo different imaging tests to determine the size and location of the tumor(s).

Once prepped for surgery, an anesthesiologist will administer the determined type of anesthesia. Your child will remain asleep for the entire surgery.

During surgery

Depending on which type of surgery they are doing, the surgeon will make the incisions. Open surgery incisions usually look like one long cut. Laparoscopic incisions are several smaller cuts.

The surgeon will access your child’s kidney either directly or through the laparoscopic incisions. Once located and assessed, they will work to remove the entire tumor and a small margin of healthy tissues around it to ensure complete cancer or disease removal.

Once the growth is completely removed, the surgeon will close the incision on the kidney to ensure it heals properly and can still function. Then, the surgeon will close all skin incisions using stitches, staples, adhesive glue or strips, or another sealing method.

After surgery

After surgery, your child may take some time waking up from anesthesia. You can expect a hospital stay of up to one week, depending on their recovery and the surgery results.

Your child may experience intense fatigue and pain at the surgery site. Their movement will be restricted while they recover. Their care team will help discuss pain medications and a recovery plan.

You can expect your child’s care team to explain the results of surgery and how much kidney function was lost. They will suggest follow-up appointments as needed.

Most children take up to 12 weeks to feel fully recovered from surgery. The newly shaped kidney must take time to learn to function in this new way.

When general anesthesia is needed, there are important rules for eating and drinking that must be followed in the hours before the surgery.

One business day before your child’s surgery, you will receive a phone call from a nurse between the hours of 1 and 9 p.m. (Nurses do not make these calls on weekends or holidays.) Please have paper and a pen ready to write down these important instructions.

The nurse will give you specific eating and drinking instructions for your child based on your child’s age.

The following are the usual instructions given for eating and drinking. No matter what age your child is, you should follow the specific instructions given to you on the phone by the nurse.

For children older than 12 months

• After midnight the night before the surgery, do not give any solid food or non-clear liquids. That includes milk, formula, juices with pulp, coffee, and chewing gum or candy.

For infants under 12 months

• Up to six hours before the scheduled arrival time, formula-fed babies may be given formula.
• Up to four hours before the scheduled arrival time, breastfed babies may nurse.

For all children

• Up to two hours before the scheduled arrival time, give only clear liquids. Clear liquids include water, Pedialyte®, Kool-Aid®, and juices you can see through, such as apple or white grape juice. Milk is not a clear liquid.
• In the 2 hours before the scheduled arrival time, give them nothing to eat or drink.

Once your child has been registered for the surgery, a member of the anesthesia staff will meet with you to take your child’s vital signs, weight, and medical history.

A pediatric anesthesiologist — a doctor who specializes in anesthesia for children — will meet with you before the surgery. They will ask questions about your child’s health and about when your child last ate.

Because your child may have eaten more recently than is usually advised for surgery, the anesthesiologist may make adjustments to your child’s anesthesia. Once admitted, your child will not be able to have anything to eat or drink until after the operation.

• As the parent or legal guardian, you will be asked to sign a consent form before the anesthesia is given.
• If your child is very scared or upset, the doctor may give a special medication to help them relax. This medication is flavored and takes effect in about 10 to 15 minutes.
• If you wish, you may be allowed to go with your child to the room where the surgery will be done and stay while the sleep medication is given.
• Younger children will get their sleep medication through a “space mask” that will carry air mixed with medication. Your child may choose a favorite scent to flavor the air flowing through the mask. There are no shots or needles used while your child is still awake.
• Older children may choose between getting their medication through a mask or directly into a vein through an intravenous (IV) line.
• When your child has fallen asleep, you will be taken to the waiting room. If it has not already been done, an IV will be started so that medication can be given to keep your child sleeping throughout the surgery.

While your child is asleep, their heart rate, blood pressure, temperature, and blood oxygen level will be checked continuously. Your child will have a breathing tube placed while they are asleep. Your child might have a sore throat after the surgery.

To keep your child asleep during the surgery, they might be given anesthetic medication by mask, through the IV tube, or both. When the surgery is over, the medications will be stopped, and your child will begin to wake up.

After surgery, your child will be moved to the recovery room to allow the anesthetic to wear off. You will be called so that you can be there as they wake up.

• Children coming out of anesthesia react in different ways. Your child might cry, be fussy or confused, feel sick to their stomach, or vomit. These reactions are normal and will go away as the anesthesia wears off.
• While your child is in recovery, your surgeon will talk to you about the surgery. This is a good time to ask questions about pain medications, diet, and activity.
• When your child is awake enough, they might be given a Popsicle® or “slushy” to drink in the recovery room.
• Once the anesthesiologist sees that your child is recovering and their pain is controlled, they will be moved to their hospital room. This usually takes about an hour, but every child is different, so times may vary.

The most important role of a parent or guardian is to help your child stay calm and relaxed before the surgery. The best way to help your child stay calm is for you to stay calm.

• You are encouraged to talk to your child or hold their hand before the surgery, while sleep medication is given, and while in recovery.
• You may bring along a “comfort” item — such as a favorite stuffed animal or “blankie” — for your child to hold before and after the surgery.

During the surgery, your child will be given numbing medication directly into the incision to relieve discomfort after the surgery. Your child will continue to receive pain medication while they are in the hospital.

Before you go home, your doctor will prescribe pain medication for your child.

After your child is discharged and goes home, they should avoid strenuous activity for the next two to four weeks. You may be given additional precautions about your child’s activity when they are discharged.

Most children take up to 12 weeks to feel fully recovered from partial nephrectomy surgery. This timeframe is important because the newly shaped kidney must take time to learn to function in a new way.

Bathing

Your child may take a shower one to three days after the surgery. Baths are allowed five to seven days after surgery.

Activity

Following the surgery, activity needs to be somewhat restricted.

• Your surgeon will determine when your child may resume normal activities.
• Your child may return to school when they feel up to it.
• Participation in contact sports and gym class is not permitted until cleared by the surgical team (typically two to four weeks after surgery).
• Swimming is usually permitted one to two weeks after surgery.
• Walking and stair climbing are encouraged.

If your child has a fever higher than 101.5 F, bleeding, or foul-smelling drainage from the area around the incisions, call your surgeon right away.

Also, call the doctor if your child has:

• Increased or unexplained pain.
• Increased swelling or redness at the incision site.
• Increased tenderness near the incision.
• Nausea, vomiting, diarrhea, or constipation that is not improving.

If you have any specific questions about your child’s surgery, you should discuss them with the surgeon before the surgery. After the surgery, you may call the Division of Pediatric General and Thoracic Surgery at UPMC Children’s and ask to speak with your child’s surgeon or speak with them during the follow-up visit, if needed.

If your child has any special needs or health issues you feel the doctor needs to know about, please call the Division of Pediatric General and Thoracic Surgery at UPMC Children's Hospital of Pittsburgh before the follow-up visit and ask to speak with a nurse. It is important to notify us in advance about any special needs your child might have.

At UPMC Children’s Hospital of Pittsburgh, every child diagnosed with kidney cancer receives an individualized treatment plan and family-centered care.

• The surgeons at UPMC Children’s have trained at the nation’s leading pediatric cancer centers. They have extensive experience performing open and laparoscopic nephrectomy and partial nephrectomy surgery to treat kidney cancer.
• Marcus Malek, MD, is a leader among the Children’s Oncology Group Surgeons.  He is also a member of the Children’s Oncology Group Renal Tumor Committee, involved in the review and research of all children in North America with kidney tumors.
• Our cutting-edge research and the latest technology ensure our patients' best possible outcomes.