radical nephrectomy
Meaning of radical nephrectomy: Taking the whole kidney out inside its fatty envelope, an operation now kept for tumors too large or awkward to cut around.
Definition of radical nephrectomy
Radical nephrectomy is surgery that removes an entire kidney together with the fat around it and the fibrous sheet enclosing that fat, so the tumor is never cut into. Nearby lymph nodes and the adrenal gland are taken as well when imaging or the position of the growth suggests they are involved. It is used mainly for kidney cancers that are large, centrally placed, or reaching beyond the kidney.
What does radical mean here?
Not aggressiveness for its own sake. It means the specimen leaves the body as a sealed package. A kidney sits inside a cushion of fat, and that cushion is wrapped in a thin fibrous sheet; removing everything within the sheet keeps the tumor covered throughout and reduces the chance of cells being spilled or left behind. The word distinguishes the operation from a simple nephrectomy, which takes the kidney alone and is done for an organ destroyed by infection, blockage or injury rather than by cancer.
Is the adrenal gland always removed?
No, and older descriptions of the operation are out of date on exactly this point. Taking the adrenal gland was part of the original description, but it proved to be involved in only a small minority of cases, and those cases can generally be anticipated from the scan or from a tumor sitting at the upper end of the kidney. It is therefore left in place unless there is a reason to take it. Clearing the lymph nodes as a routine has followed the same path: it has not been shown to lengthen survival and is now generally reserved for nodes that are visibly enlarged.
How does it compare with partial nephrectomy?
| Operation | What is removed | Usual reason |
|---|---|---|
| Simple nephrectomy | The kidney alone | A kidney ruined by infection or obstruction |
| Partial nephrectomy | The tumor with a rim of kidney around it | Small tumors, preserving working tissue |
| Radical nephrectomy | Kidney, surrounding fat and fibrous sheet | Large, central or locally invading tumors |
For a small tumor, partial nephrectomy has become the preference where it is technically possible. One kidney can support a person perfectly well, but starting with less reserve raises the chance of kidney trouble later, and cancer control for small growths is comparable either way. All three operations can be performed through a single open incision or through several small ones with a camera, with or without robotic assistance.
Used in a sentence
A radical nephrectomy was performed for a large upper pole tumor.
Good to know
The adrenal gland and a routine lymph node clearance formed part of the original description of this operation but are no longer removed as a matter of course, since involvement is uncommon and can usually be anticipated on imaging.
Word origin
Where “radical nephrectomy” comes from
Nephrectomy joins the Greek nephros, meaning kidney, with -ektome, a cutting out; radical comes from the Latin radix, a root.