Kidney Cancer Surgery · London · Nephron-Sparing Specialist

Kidney Cancer Specialist
London

Expert diagnosis, robotic nephron-sparing surgery, and survivorship care for kidney cancer — including tertiary referrals for complex and previously inoperable tumours.

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QualificationMA Cantab · MB BChir · FRCS Urol
NHS lead roleKidney Cancer Lead, SW London Network
Complexity48% of tumours RENAL score >10
Conversion to open0% in personal series

Important: Kidney cancer is increasingly found incidentally on scans — often before any symptoms develop. When treated early with kidney-preserving surgery, the long-term outlook is excellent. If you have been told a renal mass or lesion has been found, prompt specialist review is essential. Mr Sri offers some of the most advanced kidney-preserving robotic surgery available in the UK, including for complex and challenging tumours not amenable to surgery elsewhere.

Noticed blood in your urine?

Blood in the urine (haematuria) is one of the ways kidney cancer can first present. If you have not yet been investigated, please visit the haematuria clinic page first — it explains the full assessment pathway, including imaging and cystoscopy.

Haematuria — assessment and investigation →

Types of kidney cancer

The two main categories that Mr Sri manages surgically are renal cell carcinoma (RCC) — the most common form, arising from the kidney itself — and upper tract urothelial carcinoma (UTUC), which arises from the lining of the kidney's collecting system or ureter. Each requires a distinct surgical approach.

KIDNEY CANCER Renal Cell Carcinoma (RCC) Most common · arises from kidney tissue Clear cell, papillary, chromophobe subtypes Upper Tract Urothelial (UTUC) Arises from collecting system / ureter Distinct management pathway

Treatment for renal cell carcinoma — the pathway

The treatment decision for RCC depends primarily on tumour size, complexity, location, and the patient's overall kidney function and health. Mr Sri's approach always prioritises nephron preservation — saving as much healthy kidney as possible — in line with EAU (European Association of Urology) guidelines.

RCC confirmed on imaging Tumour size & complexity Small (<3cm) Active surveillance or biopsy ± proceed to surgery / cryotherapy Robotic partial nephrectomy Standard of care or cryotherapy (selected; requires biopsy) Larger / complex tumour Assessment of amenability to partial Neph Robotic partial nephrectomy Preferred if oncologically safe EAU: preserve nephrons even in large tumours Not amenable to partial Robotic radical nephrectomy ± lymph node dissection

Pathway based on EAU Guidelines on Renal Cell Carcinoma. All treatment decisions are individualised and discussed in multidisciplinary team (MDT) meeting. Scroll to view full diagram on mobile.

The importance of nephron preservation

Nephron-sparing surgery — removing the tumour while preserving the rest of the kidney — is Mr Sri's primary surgical approach and the gold standard recommended by EAU guidelines for the majority of renal masses. It is not merely about the operation today; it protects kidney function for decades, reduces the long-term risk of cardiovascular disease from chronic kidney disease and dialysis, and carries equivalent cancer control to removing the whole kidney in appropriately selected cases.

Mr Sri is one of a small group of European surgeons who routinely perform robotic retroperitoneal partial nephrectomy — approaching the kidney directly from behind, without entering the bowel cavity. This offers advantages in shorter length of stay in hospital, quicker recovery to normal day-to-day function, and fewer bowel-related side effects. Not all tumours are amenable to this approach, but Mr Sri uses this route for over 80% of his personal series.

48%
of tumours in Mr Sri's personal series have a RENAL Nephrometry Score above 10 — placing them in the highest complexity category. The ability to offer kidney-preserving surgery in this group is a defining feature of a specialist nephron-sparing practice, and reflects why patients are referred from across the UK.

Mr Sri's personal outcomes — robotic partial nephrectomy

Outcomes data is the most transparent measure of a surgeon's practice. The figures below reflect Mr Sri's personal series as of the end of 2025.

1 day
Median length of stay — most patients home the following morning
0.6%
Positive surgical margin rate — among the lowest in UK series
97%
Trifecta achievement — no major complications, negative margins, warm ischaemic time <25 mins
0.3%
Conversion to radical nephrectomy — kidney preserved in virtually all cases
0%
Conversion to open surgery — entirely minimally invasive robotic partial nephrectomy practice so far
48%
Tumours with RENAL score >10 — highest complexity classification

Surgical options — in detail

1
Robotic partial nephrectomy
Standard of care

The kidney tumour is removed while preserving the remainder of the organ. Performed robotically using the da Vinci system, with a retroperitoneal approach wherever anatomically advantageous. Suitable for the majority of renal masses — including many large and complex tumours in skilled hands. The EAU recommends nephron-sparing surgery as the first-line treatment for T1 and selected T2 tumours, and its use in more complex cases is supported by growing evidence.

Most patients are discharged after one night, with a return to normal activities within two to three weeks. Mr Sri's 0% open conversion rate and 97% trifecta achievement reflects the safety and reliability of this approach in his practice.

2
Active surveillance
Small masses · selected patients

For small renal masses (typically <3cm) in older patients or those with significant co-morbidities, active surveillance — close monitoring with serial imaging — is a valid option supported by EAU guidelines. Growth rate and change in characteristics over time guide the decision to intervene. A renal biopsy may be performed first to characterise the tumour and inform the surveillance or treatment decision.

3
Cryotherapy / thermal ablation
Selected small masses

For patients who are not surgical candidates, image-guided cryotherapy or radiofrequency ablation offers an alternative to surveillance or surgery for small, peripheral renal masses. This is typically considered for lesions under 3cm in patients with significant co-morbidities or limited life expectancy, or those declining surgery. Recurrence rates are somewhat higher than surgery. Arranged in collaboration with specialist radiology colleagues.

4
Robotic radical nephrectomy

Where partial nephrectomy is not oncologically safe — due to tumour size, location, or involvement of the renal vein — removal of the whole kidney is performed robotically. This may include lymph node dissection where nodal involvement is suspected. Mr Sri's robotic radical nephrectomy practice uses the retroperitoneal and transperitoneal approach depending on size of the kidney, maintaining the benefits of minimally invasive surgery in terms of recovery.

Upper tract urothelial carcinoma (UTUC) — a different disease

UTUC arises from the cells lining the renal pelvis and ureter — the same cell type as bladder cancer, but at a different location. It accounts for approximately 5–10% of urothelial cancers. Management follows a distinct pathway from RCC.

UTUC confirmed Disease extent Distal ureter · selected Kidney-sparing surgery Distal ureterectomy + re-implantation Upper tract / multifocal Robotic nephroureterectomy ± lymph node dissection

The standard surgical treatment for UTUC is robotic-assisted nephroureterectomy — removal of the kidney, the ureter, and a cuff of bladder. Lymph node dissection is performed where appropriate, in line with EAU guidelines on upper tract urothelial carcinoma. In selected patients with disease confined to the distal ureter, a kidney-preserving approach — distal ureterectomy with ureteric re-implantation — is a valid option that avoids loss of the kidney. All patients with UTUC require surveillance cystoscopy after treatment, as the risk of bladder recurrence is significant.

Survivorship — after kidney cancer treatment

Life after kidney cancer surgery requires structured follow-up. Mr Sri manages this through a dedicated survivorship programme, working within a multidisciplinary team.

Cancer surveillance
Regular cross-sectional imaging (CT or MRI) and blood tests to detect recurrence. Frequency and modality are risk-adapted based on tumour stage, grade, and type.
Renal function monitoring
Long-term kidney function can decline after any renal surgery. Mr Sri works closely with nephrology colleagues to monitor renal function and reduce the long-term risk of chronic kidney disease and dialysis.
Oncological support
Selected patients — particularly those with high-risk features — may benefit from adjuvant systemic therapy to reduce recurrence risk. Mr Sri works within an MDT with specialist oncologists to determine the most appropriate post-surgical treatment plan.

Second opinions and tertiary referrals

A significant proportion of Mr Sri's kidney cancer practice involves patients who have been told their tumour cannot be removed with kidney preservation, or who have been advised that open surgery is their only option, at their local or referring centre. As lead for kidney cancer services in the South West London cancer referral network, and as a high-volume retroperitoneal robotic specialist, he is a recognised tertiary and quaternary referral option for complex cases across the UK.

If you have been told your kidney tumour is not suitable for nephron-sparing surgery, or are seeking a second opinion on your treatment plan, a consultation with Mr Sri is strongly recommended before proceeding.

Published research

Mr Sri has published extensively on nephron-sparing surgery in peer-reviewed journals. Selected publications relevant to his kidney cancer practice are linked below.

Journal of Robotic Surgery · 2023
Retroperitoneal robotic partial nephrectomy as the default approach — should the paradigm shift?
Long-term outcomes from a high-volume tertiary centre demonstrating that retroperitoneal RAPN is safe and effective as standard of care for renal masses, with oncological outcomes equivalent to transperitoneal surgery and superior recovery profiles.
Read the paper →
Journal of Robotic Surgery · 2021
Robotic partial nephrectomy — standardised reporting of Trifecta and Pentafecta outcomes
A prospective observational study establishing standardised outcome benchmarks for robotic partial nephrectomy, reporting on the achievement of Trifecta (negative margins, no major complications, and WIT <25 mins) and Pentafecta criteria.
Read the paper →
The Surgeon's Notebook · dsri.co.uk
Cutting-edge kidney care: retroperitoneal robotic partial nephrectomy explained
A detailed guide to the retroperitoneal approach — why the route to the kidney matters, the technical advantages for posterior and upper pole tumours, recovery timelines, and how it compares to the transperitoneal approach in Mr Sri's practice.
Read the full article →

Frequently asked questions

A scan has found a mass on my kidney — what happens next?
The first step is a specialist consultation to review the imaging in detail and discuss the findings. Most renal masses require further characterisation — including dedicated CT or MRI — before a treatment decision is made. Whilst some small kidney lesions are benign, the majority are typically early cancers; even where cancer is suspected, there is rarely an urgent need to rush into surgery before the full picture is clear.
I have been told I need my whole kidney removed — is there another option?
Possibly, yes. Many patients who have been advised that their tumour is unsuitable for kidney-preserving surgery are found to be appropriate candidates for robotic partial nephrectomy when reviewed at a specialist centre. Mr Sri frequently operates on tumours of the highest complexity category, with a conversion to radical nephrectomy rate of just 0.3%. A second opinion consultation is always worthwhile before proceeding to kidney removal.
What is the retroperitoneal approach and why does it matter?
Most robotic kidney surgery is performed through the abdomen (transperitoneal approach), which involves working around the bowel. The retroperitoneal approach — through the back, directly behind the abdominal lining — avoids the bowel entirely. This means faster return of gut function, less post-operative bloating, and a smoother early recovery. For tumours on the back surface of the kidney, it also provides a more direct surgical route. Mr Sri is one of a small number of European surgeons who routinely use this approach.
What does recovery look like after robotic partial nephrectomy?
The great majority of patients are discharged the day after surgery. Most are mobile on the day of the operation, eating normally within hours, and return to light daily activities within one to two weeks. More strenuous activity is typically resumed at four to six weeks. Mr Sri's median length of stay in his personal series is one day.
Will losing part of my kidney affect my kidney function long-term?
A small and temporary reduction in kidney function is expected after any partial nephrectomy, but the majority of the kidney is preserved and function typically stabilises. This is far preferable to removing the whole kidney, which causes a greater and permanent reduction. Mr Sri's focus on minimising warm ischaemia time during surgery further protects long-term function. Renal function is monitored closely as part of the survivorship programme, with nephrology support where needed.
Do I need a GP referral?
No — you can self-refer directly, whether you have imaging already or are yet to be investigated. Many patients come with a scan report from another centre seeking a specialist opinion before proceeding with treatment.
Mr Denosshan Sri
MA Cantab  |  MB BChir  |  FRCS Urol  |  Consultant Urological Surgeon
Mr Sri is a consultant urological surgeon and the lead for kidney cancer services in the South West London cancer referral network at St George's University Hospital. His subspecialty focus is nephron-sparing surgery — preserving kidney tissue using advanced robotic techniques, including the retroperitoneal approach, for renal masses of all complexities. He performs over 200 robotic procedures annually, has published extensively on robotic partial nephrectomy in peer-reviewed journals, and leads the training of prospective robotic surgeons through an RCS-accredited fellowship programme. He accepts tertiary and quaternary referrals for patients with complex tumours not amenable to kidney-preserving surgery at their referring centre.
St George's NHS profile → About Mr Sri → The Surgeon's Notebook →

Clinic locations

Mr Sri sees patients at three private hospital locations in and around London.

Spire St Anthony's
801 London Road
Cheam, Surrey SM3 9DW

Tel: 020 8337 6691
Nuffield Parkside
53 Parkside
Wimbledon SW19 5NX

Tel: 020 8971 8000
HCA Princess Grace
18 Devonshire Street
Marylebone W1G 7AF

Tel: 020 379 77248

Kidney mass found? Seeking a second opinion?

Same-week appointments available — including for complex tertiary referrals.
No GP referral required. Self-pay and all major insurers accepted.

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