Kidney Cancer: Partial and Radical Nephrectomy
Most kidney tumours are found incidentally on imaging done for another reason. The real question is not whether to remove the tumour but how much of the kidney can be preserved.
Last medically reviewed: October 4, 2026 — Assoc. Prof. Dr. Müslüm Ergün
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- Procedure time
- 2–4 hours
- Anesthesia
- General anaesthesia
- Hospital stay
- 2–4 nights
- Stay in Türkiye
- 10–14 days
- Return to work
- 2–4 weeks
- Flight clearance
- 10–14 days
About the condition
Kidney cancer is a tumour arising from the tissue of the kidney that filters urine. This page deals mainly with renal cell carcinoma, the commonest type in adults.
MOST TUMOURS ARE FOUND INCIDENTALLY. The triad once described — flank pain, blood in the urine and a palpable mass — is now uncommon, and when it is present the disease is usually advanced. Today the great majority of kidney tumours are picked up by chance on an ultrasound or CT scan done for some other complaint. Waiting for symptoms is therefore not a sound strategy.
The diagnosis is made on imaging. Contrast-enhanced CT or MRI shows how the mass takes up blood supply and distinguishes it from a benign structure such as a simple cyst or an angiomyolipoma. Biopsy is not performed in every patient with a kidney tumour; imaging is usually informative enough, and a biopsy is requested only when it would change the decision.
THE REAL QUESTION IS: HOW MUCH OF THE KIDNEY CAN BE PRESERVED? In small, favourably placed tumours only the tumour and a thin rim of surrounding tissue are removed (partial nephrectomy), and the rest of the kidney carries on working. In large, centrally placed tumours or those encasing the blood vessels, the whole kidney is removed (radical nephrectomy).
WHY DOES PRESERVING KIDNEY TISSUE MATTER? Because a problem may arise in the other kidney in the future, and a loss of kidney function also affects cardiovascular health. For that reason partial nephrectomy is preferred where it is technically possible and oncologically safe. But "where possible" matters: removing the tumour completely always comes first.
ACTIVE SURVEILLANCE IS A LEGITIMATE OPTION FOR SMALL MASSES. Some very small tumours grow slowly and some are benign. In older patients or those at high surgical risk, imaging the mass at set intervals and intervening only if it grows is an accepted approach. Not every mass needs to be operated on straight away.
Who is it suitable for?
May be suitable
- Patients found on imaging to have a solid mass in the kidney
- Patients with a small, peripherally placed tumour — suitable for partial nephrectomy
- Patients with a single kidney or a problem in the other kidney — preserving kidney tissue takes priority
- Patients with borderline kidney function — the partial approach becomes even more important
- Patients with a large or centrally placed tumour — radical nephrectomy comes into consideration
May not be suitable
- Patients found to have a simple kidney cyst — this is not a tumour and often needs no follow-up at all
- Masses shown by their fat content on imaging to be benign (angiomyolipoma) — assessed separately
- Older patients or those at high surgical risk with a very small mass — active surveillance is discussed first
- Patients whose general condition is unsuited to major surgery — ablation techniques or surveillance are considered
- Patients with widespread disease — the treatment priority may be systemic therapy rather than surgery
Technology used
- Characterising the mass with contrast-enhanced CT or MRI
- Laparoscopic or robotic approach
- Partial nephrectomy — removing the tumour while preserving the kidney
- Radical nephrectomy — where required
- Pathological examination and staging
- Monitoring kidney function before and after surgery
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Step 1
Characterising the mass
Contrast-enhanced CT or MRI establishes whether the mass is solid or cystic, its size and its position within the kidney. This shows whether partial surgery is feasible.
- Step 2
Staging and general assessment
Chest imaging and blood tests are carried out. Kidney function is measured; the state of the other kidney is particularly important.
- Step 3
The decision: surveillance or surgery?
Active surveillance is discussed for small masses and where surgical risk is high. If surgery is decided on, whether it will be partial or radical is planned.
- Day of surgery
The operation
Access is gained laparoscopically or robotically under general anaesthesia. In partial nephrectomy the tumour is removed with a thin rim of tissue around it and the kidney is repaired. The operation takes 2–4 hours.
- Days 2–4
Discharge
The drain and catheter are removed when appropriate, kidney function is checked and the patient is discharged.
- Weeks 4–6
Pathology and follow-up plan
The type and stage of the tumour are established from the pathology report, and the follow-up intervals are planned accordingly.
Method comparison
| Criterion | Partial nephrectomy | Radical nephrectomy |
|---|---|---|
| What is removed | Only the tumour and a thin rim of tissue | The whole kidney |
| Suitable tumour | Small, peripherally placed | Large, central or involving the vessels |
| Kidney function | Better preserved | That kidney’s function is lost |
| Risk of bleeding and urine leak | Higher | Lower |
| Technical demand | Higher | Lower |
| In a patient with one kidney | The primary aim | A last resort |
Partial nephrectomy is preferred where possible because preserved kidney tissue matters in the long run. But removing the tumour completely always comes first; oncological safety takes precedence over preserving kidney tissue.
Risks
- Bleeding — the kidney has a rich blood supply; this risk is watched particularly closely in partial nephrectomy and a transfusion is rarely needed
- Urine leak — specific to partial nephrectomy; it can occur with tumours close to the collecting system and may require the drain to stay in longer
- A fall in kidney function — more marked after radical nephrectomy; this is the reason the partial approach is preferred
- Converting from partial to radical during the operation — this arises if the position of the tumour proves different from expected and is discussed beforehand
- Injury to a neighbouring organ — uncommon
- Infection, wound problems and the general risks of a long operation
- RECURRENCE: even after the tumour has been removed, the disease can return years later; a follow-up plan is therefore made and must be kept to
Alternatives
- Active surveillance — a legitimate option for small masses, in older patients or where surgical risk is high
- Partial nephrectomy — preferred where possible and safe
- Radical nephrectomy — for large, central tumours or those involving the vessels
- Ablation techniques (destroying the tumour by freezing or heat) — for small masses and patients unsuited to surgery
- Systemic therapy in widespread disease — planned together with medical oncology
Recovery
First 48 hours
The patient stays in hospital under observation. Pain is controlled and getting up early is encouraged. The drain and catheter are monitored.
Days 2–4
The drain and catheter are removed when appropriate. Kidney function is checked and discharge is planned.
Weeks 1–2
Gentle walking is allowed. Heavy lifting and movements that strain the abdominal muscles are not.
Weeks 2–4
A return to desk work is possible. Longer is needed before heavy physical work.
Month 3 onwards
Imaging and monitoring of kidney function continue at intervals set by the pathology result.
Frequently asked questions
I had no symptoms and it was found by chance. Is that a bad sign?
On the contrary. Most kidney tumours today are found incidentally, and that usually means the disease has been caught at an early stage. When the classic triad of flank pain, blood in the urine and a palpable mass is present, the disease is usually advanced. Being found without symptoms is a good position to be in.
Will my whole kidney be removed?
That depends on the size and position of the tumour. In small, peripherally placed tumours only the tumour is removed and the rest of the kidney is preserved. In large or central tumours, or those encasing the vessels, the whole kidney may have to be removed. Imaging largely shows this in advance.
Will a biopsy be done?
A biopsy is not performed in every patient with a kidney tumour. Contrast-enhanced imaging is usually informative enough. A biopsy is requested only when the result would change the treatment decision — for instance when active surveillance versus surgery is being weighed, or when it is unclear whether the tumour arises from the kidney at all.
I have a small mass — must I have surgery straight away?
Not necessarily. Some very small masses grow slowly and some are benign. Particularly in older patients or those at high surgical risk, imaging the mass at intervals and intervening only if it grows is an accepted approach. That is not neglect but a deliberate decision.
Can I live with one kidney?
Yes — if the remaining kidney is healthy it generally provides enough function. But that does not mean preserving kidney tissue is unimportant; a problem may arise in the other kidney later, and a loss of kidney function also affects cardiovascular health. That is why partial surgery is preferred where possible.
Can the plan change during the operation?
Yes. If the position of the tumour proves different from expected, a planned partial nephrectomy may be converted to a radical one. That is not a failure but a decision that safeguards complete removal of the tumour, and it is discussed with you beforehand.
Is follow-up needed after the tumour is removed?
Yes. Even when the tumour has been removed completely, the disease can return years later. The intervals are set by the pathology result and the stage: less frequent imaging in low-risk disease, more frequent in high-risk.
A kidney cyst was found — is that cancer?
Simple kidney cysts are very common and are not cancer; most need no follow-up at all. If the cyst has septa, a thickened wall or a part that takes up contrast, the assessment differs. If the report says "simple cyst", there is nothing to be concerned about.
When can I fly?
Usually after 10–14 days. This is an operation inside the abdomen that needs time to heal, and flying early raises the risk of clots in the leg veins. A stay of 10–14 days is planned for patients travelling from abroad.
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This page is for general information only and is not a substitute for medical advice.
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