Localized Disease. Radical nephrectomy was previously the initial standard of care for the treatment of all localized RCCs. The operation involves complete removal of the kidney and suprarenal (adrenal) gland within the renal fascia, as well as removal of regional lymph nodes from the crus of the diaphragm to the aortic bifurcation. The surgery can be performed using either an open or laparoscopic approach and results in an extremely low local recurrence rate (2% to 3%). Laparoscopic radical nephrectomy, however, has become increasingly popular in recent years because of shorter recovery times and equivalent oncologic outcomes when compared with the open approach. Thus it is now considered the treatment of choice for patients with localized tumors less than 10 cm in diameter with no local invasion, renal vein involvement, or lymph node metastasis.