Radical nephrectomy

Surgery that removes the whole kidney, with the fat around it, to treat a kidney cancer that is too large or too central to remove on its own.

Also called nephrectomy, total nephrectomy, robotic radical nephrectomy, laparoscopic radical nephrectomy, LRN, open nephrectomy, kidney removal, remove my kidney

Where: Hospital operating room
Anesthesia: General anesthesia (you are fully asleep)
Time in the room: About 2 to 4 hours; longer for very large tumors or a tumor in the vena cava
Hospital stay: Usually 1 to 2 nights after keyhole surgery; about 3 to 5 nights after open surgery
Back to normal: About 3 to 6 weeks, longer after open surgery
Back to work: Desk work in 2 to 4 weeks; physical work in about 6 weeks or more

See the steps

KidneyTumorAdrenal glandRenal arteryRenal vein

Where it happens. The highlighted part is what this procedure treats.

Overview

A radical nephrectomy removes the whole kidney together with the fat and thin covering around it, called Gerota's fascia, in one package. Removing the fat with the kidney matters because kidney cancer can grow into that fat. Most of these operations today are done through small keyhole cuts, with a surgical robot or with standard laparoscopic instruments. Very large tumors, or tumors that grow into the large vein, are often done through one larger open cut.

Your surgeon recommends removing the whole kidney when the tumor is large, sits deep in the center of the kidney near its main vessels, or has replaced so much of the kidney that saving part of it would leave little working tissue or be unsafe. For many small tumors a partial nephrectomy, which removes only the tumor, is preferred. Most people live a full, normal life with one healthy kidney.

The adrenal gland, a small hormone gland that sits on top of the kidney, used to be removed every time. Today it is usually left in place unless the tumor touches it, grows into it, or looks abnormal on the scan. Lymph nodes near the kidney are removed when they look enlarged or when the tumor has high-risk features.

In a small number of people, the cancer grows as a finger-like plug, called a tumor thrombus, into the kidney vein and sometimes up the inferior vena cava, the body's largest vein, toward the heart. This can still often be cured with surgery, but the operation is larger. It is usually done open, at a center with experience, sometimes together with a vascular or heart surgeon.

The parts of your body involved

You have two kidneys, each about the size of your fist, high in the back of your belly under the lower ribs. They filter your blood and make urine. Each kidney is wrapped in fat and a thin covering called Gerota's fascia. The renal artery brings blood in and the renal vein carries it out to the vena cava, the large vein that returns blood to the heart. Urine drains from the kidney down a thin tube called the ureter to the bladder. A small adrenal gland sits on top of each kidney and makes stress and salt-balance hormones.

Kidney
The organ being removed. The other kidney takes over the job of filtering.
Gerota's fat
The fat and thin covering around the kidney. It is removed with the kidney because cancer can grow into it.
Renal artery and vein
The main blood vessels at the kidney's doorway, sealed and divided during the operation.
Ureter
The tube that drains urine to the bladder. It is clipped and cut below the kidney.
Adrenal gland
A small hormone gland on top of the kidney. It is usually left in place unless the tumor is near it.
Vena cava
The body's largest vein. Rarely, a kidney tumor grows into it.

Why it’s done

The aim is to remove the cancer completely, with a margin of the surrounding fat, while keeping the operation as safe as possible. Your urologist weighs the size and position of the tumor, how well your other kidney works, and your overall health.

The tumor is large
Tumors larger than about 7 centimeters (about 3 inches) are usually treated by removing the whole kidney, although some can still be treated with a partial.
The tumor is central or complex
Tumors deep in the middle of the kidney, wrapped around the main vessels or drainage system, may not be safely removable on their own.
Little healthy kidney would be left
If the tumor has replaced most of the kidney, saving the rest would add risk without much benefit.
Tumor in the vein
When the cancer grows into the kidney vein or vena cava, the kidney and the tumor plug are removed together.
Cancer that has spread, in selected people
For some people with cancer that has spread, removing the main tumor can help, usually alongside medicines. This decision is made with a cancer medicine specialist.

Other options

Partial nephrectomy
Removes only the tumor and keeps the rest of the kidney. Preferred for most small tumors and for anyone with one kidney or reduced kidney function, when it can be done safely.
Active surveillance (watching with scans)
For small tumors in older people or people with serious health problems, watching with regular scans may be reasonable. It is rarely a good choice for large tumors.
Ablation (freezing or heating)
Needle treatment through the skin. It works best for tumors up to about 3 centimeters, so it is usually not an option for tumors large enough to need a radical nephrectomy.
Medicines first
For cancer that has spread, immunotherapy and targeted drugs are often the first treatment, with surgery considered later or not at all.
A biopsy before deciding
A needle biopsy can confirm the tumor type when the diagnosis is unclear or when medicines might be used before or instead of surgery.

In the operating room, step by step

Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.

YouAnesthesia teamOperating table

1 / 12

1. Going to sleep and lying on your side

You fall fully asleep with medicine through your IV and a breathing tube is placed. You are turned onto your side with the tumor side up, and the table is bent slightly at the waist. A catheter is placed in your bladder to drain urine.

More detail

For a large tumor in the vena cava, you may lie on your back instead, and the team may use ultrasound through the esophagus to watch the tumor plug and the heart during the operation.

You fall fully asleep with medicine through your IV and a breathing tube is placed. You are turned onto your side with the tumor side up, and the table is bent slightly at the waist. A catheter is placed in your bladder to drain urine.
More detail
For a large tumor in the vena cava, you may lie on your back instead, and the team may use ultrasound through the esophagus to watch the tumor plug and the heart during the operation.
Your surgeon makes 4 or 5 small cuts on the side of your belly, each about the width of a fingertip, and fills the belly with carbon dioxide gas to make room. Thin tubes called ports hold the camera and instruments.
More detail
In open surgery, one larger cut is made instead, either along the side below the ribs, under the ribs across the upper belly, or down the middle. Open surgery is chosen for very large tumors and most tumors in the vena cava. The drawings show a left kidney; the right side is a mirror image, with an extra small port to lift the liver.
In robotic surgery, the robot's arms are attached to the ports and your surgeon controls them from a console in the room. In laparoscopic surgery, your surgeon stands at the table and holds long instruments directly. Both use a camera and a video screen, and the results are similar.
The colon, the large bowel, is gently moved toward the middle to uncover the kidney, which stays wrapped in its fat. Your surgeon finds the ureter below the kidney and lifts it, along with the kidney's lower end, to follow it up toward the main blood vessels.
At the kidney's doorway, called the hilum, your surgeon carefully frees the renal artery and renal vein. The artery is handled first, so the kidney stops filling with blood before the vein that drains it is closed.
More detail
Large tumors often have extra veins and arteries around them, and the surgeon looks for every one. If enlarged lymph nodes are seen near the vessels or the tumor has high-risk features, they are removed at this point for testing.
The renal artery is sealed with a stapler or strong clips and cut. Then the renal vein is sealed and cut. These seals stay in your body permanently and cause no problems.
More detail
When a tumor plug extends into the renal vein or vena cava, the operation changes here. The surgeon controls the vena cava above and below the plug, opens it, removes the plug with the kidney, and sews the vein closed. If the plug reaches near or into the heart, a heart surgeon may join, sometimes using a heart-lung bypass machine.
The ureter is closed with clips and cut a few inches below the kidney. The lower end stays connected to your bladder and simply stops carrying urine from that side.
At the top of the kidney, your surgeon separates the kidney from the adrenal gland and leaves the gland in place. If the tumor is in the upper part of the kidney and touches or grows into the adrenal, or if the gland looks abnormal on the scan, it is removed with the kidney instead.
More detail
Keeping the adrenal is now standard when it looks normal, because removing it rarely adds cancer benefit and the gland still makes useful hormones. Losing one adrenal does not cause hormone problems if the other one works normally.
The last attachments at the back and sides are released, and the kidney comes free inside its fat. It is placed in a strong plastic bag inside the belly so no tumor cells spill while it is removed.
With the kidney out of the way, your surgeon checks the staple lines and the space for any bleeding, often with the gas pressure lowered. A drain is rarely needed but may be placed if lymph nodes were removed or the operation was complex.
The bag is pulled out through one cut that is widened to a few inches, often low on the belly or near one of the ports. Its size depends on the size of the tumor. The kidney goes to the pathologist, a doctor who examines tissue under a microscope.
The gas is let out and the muscle layer of the larger cut is closed with strong stitches to prevent a hernia. The skin is closed with dissolving stitches and covered with glue or strips. You wake up in the recovery room.

Your surgeon is in control the whole time

The surgeon sits at a console a few steps from you and moves every instrument with hand controls and foot pedals. The robot cannot move on its own or make decisions.

A magnified 3D view

A camera on one arm gives the surgeon a bright, three-dimensional picture magnified about ten times, which helps them see small nerves and vessels.

Wristed instruments through keyholes

The instruments are about the width of a pencil and bend like a wrist inside your body, so the surgeon can stitch and dissect through small openings.

A team at your side

A bedside assistant and a scrub nurse stay at the table, and the anesthesia team watches your breathing and blood pressure throughout. Most U.S. hospitals use the da Vinci system made by Intuitive.

After the operation

In the hospital

Waking up
You wake with an IV, a bladder catheter, and squeezing sleeves on your legs. You may feel groggy and sore for several hours.
Pain control
Scheduled acetaminophen and other non-opioid medicines are the base, with opioid medicine added only if needed. Ibuprofen-type medicines are usually avoided because you now have one kidney.
Walking
You are helped up to walk the same evening or the next morning, and then several times a day.
Eating
Clear liquids start soon after surgery, with regular food usually the next day.
Blood tests
Your blood count and creatinine are checked. A rise in creatinine is expected after removing a kidney.
Going home
The catheter usually comes out on day 1. Most people go home in 1 to 2 days after keyhole surgery, or 3 to 5 days after open surgery.

At home

Pain
Soreness at the cuts, especially the larger one, and a deep ache on that side are normal for 1 to 3 weeks. Use acetaminophen on a schedule and the stronger pill only if needed.
Protect your one kidney
Avoid ibuprofen, naproxen and similar pain pills unless your doctor says they are okay. Tell every doctor and pharmacist that you have one kidney, and ask before any scan with contrast dye.
Incisions
Skin glue falls off in 1 to 2 weeks. Shower after 24 to 48 hours and pat dry. Avoid baths, hot tubs and swimming for about 2 to 4 weeks.
Diet and fluids
Eat normally. Drink enough to keep your urine pale yellow. A heart-healthy diet with less salt helps protect your remaining kidney.
Bowels
Take a stool softener while on opioid pain medicine. Bloating and gas are common for the first week.
Activity and lifting
Walk several times a day. Avoid lifting more than about 10 to 15 pounds (5 to 7 kilograms) and hard exercise for about 6 weeks, longer after open surgery.
Driving
Do not drive while taking opioid pain medicine. Most people drive again in about 2 weeks after keyhole surgery.
Sex
When you feel comfortable, often after 2 to 4 weeks.
Work
Desk work in about 2 to 4 weeks; physical work in about 6 weeks, longer after open surgery.

Recovery timeline

Day of surgery
Surgery
You wake in recovery and usually sit up or walk that evening.
Days 1 to 2
Home after keyhole surgery
The catheter comes out, you eat, walk, and go home. After open surgery, expect 3 to 5 days in the hospital.
Week 1
Pathology report
The report is often ready in about a week. It gives the tumor type, grade and stage, which set your follow-up plan.
Weeks 2 to 4
Getting stronger
Pain fades, energy slowly improves, and many people return to desk work and driving.
About 6 weeks
Back to most activities
Lifting limits are usually lifted after keyhole surgery.
1 to 3 months
Kidney function settles
Your remaining kidney grows slightly and works harder. Creatinine is checked to see where it settles.
3 to 6 months
First scans
A CT or MRI of the belly and imaging of the chest are often done within the first several months, depending on your risk.
Years 1 to 5 and beyond
Ongoing follow-up
Scans, kidney function and blood pressure checks continue on a schedule based on the tumor's risk, often for 5 years or longer.

What it feels like

Removing a kidney sounds frightening, and many people worry about living with one. Most find the recovery steady but tiring, and the emotional weight of a cancer diagnosis often outlasts the physical soreness.

Hearing you need the whole kidney removed
Many people feel loss and worry about whether one kidney is enough, and whether they will need dialysis.
What helpsAsk your team to show you your kidney function numbers and what they expect afterward. Most people with a healthy other kidney never need dialysis.
Waking up
Grogginess, a sore throat from the breathing tube, and the urge to urinate from the catheter are common.
What helpsTell the nurse about pain or nausea early. The catheter usually comes out the next day.
The first day or two
Shoulder-tip pain from the gas, a sore side, and bloating. Coughing and getting out of bed pull on the cuts.
What helpsWalk often; it eases the gas pain and bloating. Hug a pillow against your belly when you cough or sit up.
The first weeks at home
Tiredness is often bigger than pain, and some people feel low or teary. The larger cut can feel numb or tight.
What helpsPlan naps and short walks. Accept help with chores. Numbness around a cut is common and often improves over months.
Getting the pathology report
This is often the most anxious moment, waiting to hear the stage and whether more treatment is needed.
What helpsBring someone to the visit and write down the type, grade and stage. Ask what they mean for you and what the follow-up plan is.
Living with one kidney
Some people feel protective of their remaining kidney and unsure what they can eat, drink or do.
What helpsMost people live normally. Keep blood pressure and blood sugar in check, avoid ibuprofen-type medicines unless approved, and get yearly kidney function blood tests.

How well it works

Success means the whole tumor is removed with clear edges, the cancer does not come back, and your remaining kidney keeps you healthy. The pathology report and follow-up scans tell you where you stand.

Stage and grade
The pathology report gives the tumor type, its grade (how aggressive the cells look), whether it grew into the fat or vein, and whether any lymph nodes contained cancer.
Clear margins
Margins are usually clear after a radical nephrectomy because the kidney is removed inside its fat.
Kidney function
Your eGFR, a blood test estimate of filtering, often falls by about a third at first and then partly recovers as the other kidney works harder. Many people settle at a lower but stable level.
Follow-up scans
CT or MRI of the belly and imaging of the chest follow a schedule based on the risk of the tumor, often for at least 5 years.
Treatment after surgery, if needed
For some people with high-risk clear cell kidney cancer, a year of immunotherapy after surgery lowers the chance of the cancer coming back. Your team will tell you whether this applies to you.

Risks

Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.

Common

Pain and tiredness

Expected for several weeks, more after open surgery.

Shoulder-tip pain from gas

Usually fades in 1 to 3 days after keyhole surgery.

Lower kidney function

Removing a kidney lowers your total kidney function. Many people end up with an eGFR in the range called stage 3 chronic kidney disease, which usually stays stable.

Bloating and constipation

From anesthesia and pain medicine; usually settles within a week.

Numbness near the cut

Small skin nerves are cut, so an area near the larger incision can feel numb for months.

Less common

Bleeding needing a transfusion

More likely with large tumors or tumors in the vena cava.

Infection

Urinary infection, wound infection or pneumonia, usually treated with antibiotics.

Change to open surgery

Sometimes needed for bleeding, scar tissue or a very large tumor.

Slow bowel recovery (ileus)

The bowels may take a few days to wake up, causing bloating and nausea.

Hernia at the larger cut

A bulge can form at the extraction site, sometimes months later. It can be repaired.

Rare

Injury to nearby organs

The spleen, pancreas, liver, bowel, large blood vessels or the lining of the lung can rarely be injured. Most injuries are recognized and repaired during surgery.

Blood clots

A clot in a leg vein that can travel to the lungs. Walking and blood-thinner shots lower the risk.

Lymph fluid leak

After lymph nodes are removed, milky lymph fluid can rarely collect in the belly. It is usually managed with diet changes.

Need for dialysis

Very rare when the remaining kidney is healthy. The risk is higher if kidney function was already low.

Death

Very rare for routine operations. The risk is higher for large tumors in the vena cava, which your team will discuss with you.

Call your care team or go to the emergency room if

Fever of 101°F (38.3°C) or higher, or shaking chills
Feeling faint, a racing heart, or new severe pain in the side or belly
Very little urine (much less than usual) for most of a day, or swelling in your legs and face
Pain, swelling or redness in one calf, or chest pain or trouble breathing (call 911)
Vomiting that will not stop, a swollen belly, or no gas or bowel movement for more than 3 days
Redness spreading from a cut, pus, or a cut that opens
Milky or clear fluid leaking from a cut, or a belly that keeps swelling
Pain that your prescribed medicine does not control

Questions to ask your surgeon

Why do you recommend removing the whole kidney rather than a partial?
Will you do this robotic, laparoscopic or open, and why?
Will you leave my adrenal gland?
Will you remove any lymph nodes?
Does the tumor go into the kidney vein or vena cava?
How well does my other kidney work, and what do you expect my kidney function to be afterward?
How many of these operations do you do each year?
Will I need any treatment after surgery?
What follow-up scans will I need, and how often?
What medicines should I avoid with one kidney?
When can I go back to work and lift normally?

Words you may hear

Radical nephrectomy: Surgery to remove the whole kidney with the fat and covering around it.
Renal cell carcinoma: The most common type of kidney cancer.
Gerota's fascia: The thin covering around the kidney and its fat, removed with the kidney in this operation.
Hilum: The kidney's doorway, where the artery, vein and ureter enter and leave.
Adrenal gland: A small gland on top of each kidney that makes stress and salt-balance hormones.
Inferior vena cava (IVC): The body's largest vein, which carries blood from the lower body back to the heart.
Tumor thrombus: A finger-like plug of tumor growing inside a vein.
Lymph nodes: Small bean-shaped glands that filter fluid and can trap cancer cells.
Cytoreductive nephrectomy: Removing the kidney tumor when cancer has already spread, to lower the total amount of cancer in the body.
eGFR: A blood test estimate of how well your kidneys filter.
Chronic kidney disease: Long-term reduced kidney function, graded in stages by eGFR.
Pathologist: A doctor who examines removed tissue under a microscope and writes the diagnosis.

Common questions

Can I live normally with one kidney?

Yes. Most people live normal, full lives with one healthy kidney. Your remaining kidney grows slightly and takes on more of the work. Yearly blood pressure and kidney function checks, and avoiding medicines that strain the kidney, help keep it healthy.

Will I need dialysis?

Very unlikely if your other kidney is healthy. The risk is higher if your kidney function is already low or if you have diabetes or kidney disease, which is one reason surgeons try to save the kidney when they safely can.

Why not just remove the tumor?

For large or deep tumors, removing only the tumor can be unsafe or leave too little working kidney, and the cancer control may be worse. Your surgeon can show you on your scan why they recommend removing the whole kidney.

What if the tumor is in the vena cava?

A tumor plug in the vena cava is uncommon but can often be removed with the kidney. The operation is bigger and usually open, sometimes with a vascular or heart surgeon. Many people are cured, especially when the cancer has not spread elsewhere.

Will they take my adrenal gland?

Usually not. It is left in place unless the tumor touches it, grows into it, or it looks abnormal on the scan. Even if one adrenal is removed, the other normally makes enough hormones.

Will I need chemotherapy or immunotherapy?

Many people need no further treatment. For high-risk clear cell kidney cancer, a year of immunotherapy after surgery may be offered. If the cancer has spread, medicines are usually the main treatment.

Sources this page draws on

American Urological Association, Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-up: AUA Guideline (2021)
European Association of Urology, EAU Guidelines on Renal Cell Carcinoma
American Cancer Society, Surgery for Kidney Cancer
Urology Care Foundation, Kidney Cancer
New England Journal of Medicine, KEYNOTE-564 trial: Adjuvant pembrolizumab after nephrectomy in renal-cell carcinoma (Choueiri et al.) (2021)

Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.

Radical nephrectomy

Overview

The parts of your body involved

Why it’s done

Other options

Getting ready

2 to 4 weeks before

The week before

The day before

The morning of surgery

In the operating room, step by step

1. Going to sleep and lying on your side

After the operation

In the hospital

At home

Recovery timeline

What it feels like

Hearing you need the whole kidney removed

Waking up

The first day or two

The first weeks at home

Getting the pathology report

Living with one kidney