During a radical operation, the renal vessels are first identified, since early occlusion of the kidney's blood supply appears to reduce the risk for spreading of tumor cells via blood during the procedure. The kidney is removed with the renal fascia and fat capsule intact.The adrenal glands are included when a preoperative CT shows suspicious findings. Localized renal cell carcinoma in an otherwise healthy patient should be treated by transperitoneal radical nephrectomy, either by open surgery or laparoscopic. In an obese patient, nephrectomy through the flank is recommended. For large tumors, thoracoabdominal access may be advantageous.
Increasing usage of image diagnostics has led to an increase in the number of tumors discovered by coincidence during examination for other diseases or symptoms. Coincidentally diagnosed kidney tumors are generally smaller, at a lower stage, and survival is better than in patients with clinical symptoms from the tumor. Based on this and due to improved postoperative follow-up possibilities, nepron-sparing surgery is increasingly used on patients with small tumors (< 7 cm).
Minimal invasive surgery in the form of laparoscopic nephrectomy/renal resection is now the most common access in most hospitals.
Embolization of renal artery
The renal artery is easily catheterized by a radiologist and may be occluded by injection of various forms of particles. This should be considered before planned surgery on large tumors.
Embolization of the renal artery does not increase rate of cure, but may reduce the danger of bleeding and simplify the surgical resection.
Embolization of the renal artery is also indicated for tumor bleeding into the urinary tracts (massive hematuria).