Kidney Cancer Specialist London | Second Opinion & Tertiary Referrals — Mr Denosshan Sri
Kidney Cancer · Central London · Marylebone · Harley Street area

Kidney cancer second opinions & tertiary referrals — London

A meaningful proportion of Mr Sri's kidney cancer practice involves patients told elsewhere that their tumour cannot be removed without losing the whole kidney. Many are found, on specialist review, to be candidates for nephron-sparing surgery. Consultations at HCA Princess Grace Hospital, Marylebone — minutes from Harley Street.

Self-referral and tertiary referrals accepted · International patients welcome · Same-week appointments · Imaging review possible before in-person consultation

97%Trifecta rate
(personal series)
48%RENAL score >10
(highest complexity)
0.3%Conversion to
radical nephrectomy
0%Open conversion
across series
0Tumour recurrences
to date
A specific kind of practice

"You will need your whole kidney removed." Then, sometimes — you don't.

A second opinion before kidney surgery is not indecision. It is good judgment. Renal tumours are technically variable — what one team considers unsafe for nephron-sparing surgery, another may consider straightforward. The difference frequently comes down to surgeon volume, technique, and access to the retroperitoneal approach.

Mr Sri operates on tumours of the highest complexity category (RENAL score >10) as 48% of his practice — with a 0.3% rate of conversion to radical nephrectomy. Where it is technically possible to preserve the kidney, that is the priority — every single time.

This page describes how to access this practice in Central London for a second opinion or tertiary referral. The clinical detail of kidney cancer treatment is on the main kidney cancer page; the surgical procedure detail is on the London partial nephrectomy page.

Who comes for a second opinion in London

Six common reasons patients ask for a specialist review

Mr Sri sees patients referred by other consultants, by GPs, and patients who have found this practice independently. All are equally welcome. The reasons people seek a London-based specialist opinion follow recognisable patterns.

01
Told that nephron-sparing isn't possible
Most common scenario. You have been recommended radical nephrectomy — removal of the whole kidney — at your local hospital. A specialist review at a high-volume centre may identify whether kidney-preserving surgery is technically feasible.
02
Tumour declined for partial nephrectomy elsewhere in London
Quaternary referrals from other London centres are routine. Tumours rated as RENAL score >10, hilar, endophytic, or in solitary kidneys are precisely the case mix that defines this practice — 48% of operations.
03
Considering active surveillance — wanting surgical input
Active surveillance is appropriate for selected small tumours, but the alternative — a minimally invasive partial nephrectomy with rapid recovery — is increasingly preferred by patients who want definitive treatment. A surgical perspective on the trade-offs is reasonable to seek.
04
Previous abdominal surgery making transperitoneal access difficult
The retroperitoneal approach completely avoids the peritoneal cavity, making it the approach of choice for patients with previous abdominal or pelvic surgery where adhesions make transperitoneal access hazardous.
05
International patients seeking specialist UK care
HCA Princess Grace has an established international patient pathway: concierge service, interpreter support, proximity to West End hotels, easy access from Heathrow via the Elizabeth line and from St Pancras. Pre-consultation imaging review is possible to determine candidacy before travel.
06
Solitary kidney patients
Where every nephron matters — including patients with only one functioning kidney — nephron-sparing surgery is not optional, it is essential. The technical demands are higher, but so is the clinical imperative. Mr Sri accepts these referrals from across the UK and internationally.
The substance behind the claim

Outcomes that justify the referral

A second opinion only matters if it leads to better care. The figures below represent Mr Sri's personal robotic partial nephrectomy series as of end 2025. Full data is available on the London partial nephrectomy page.

97%
Trifecta rate — negative margins, no major complications, warm ischaemia <25 mins
86%
Trifecta rate including minor complications — a more stringent international benchmark
0.6%
Positive surgical margin rate — among the lowest in published UK series
0%
Conversion to open surgery — entirely minimally invasive practice to date
0.3%
Conversion to radical nephrectomy where partial had been planned
0.3%
Delayed bleeding requiring embolisation — managed without open surgery
0.3%
Urine leak rate — managed conservatively in all cases
0
Tumour recurrences in Mr Sri's consultant career to date
The technique that drives the difference

Retroperitoneal robotic partial nephrectomy — Mr Sri's signature approach

Most robotic kidney surgery is performed transperitoneally — through the abdomen, with the bowel moved aside. Mr Sri operates retroperitoneally — directly through the back, without ever entering the peritoneal cavity. He introduced this approach to South West London and now performs it as his default technique.

For posterior tumours, hilar tumours, patients with previous abdominal surgery, and high-BMI patients, this approach offers technical and recovery advantages that are clinically significant — and it is what allows nephron-sparing surgery to be offered in cases where the transperitoneal approach would be unsafe.

Mr Sri has published extensively on this technique in peer-reviewed journals.

2023
Long-term experience of robotic retroperitoneal partial nephrectomy as the default approach in the management of renal masses: should the paradigm shift?
Journal of Robotic Surgery · Vol 17, pp 2001–2008
Read paper →
2021
Robotic-assisted partial nephrectomy (RAPN) and standardisation of outcome reporting: prospective study on Trifecta and Pentafecta achievement
Journal of Robotic Surgery
Read paper →
Notebook
Cutting-edge kidney care: retroperitoneal robotic partial nephrectomy explained
The Surgeon's Notebook · Patient-facing
Read article →

Where you'll be seen — HCA Princess Grace, Marylebone

Mr Sri's London consulting and surgical base is HCA Princess Grace Hospital — one of London's foremost private hospitals, with a dedicated robotic surgical theatre and an established international patient pathway. The hospital sits in the heart of London's medical district, minutes from Harley Street.

Surgical & consulting venue · W1
HCA Princess Grace Hospital
Address
18 Devonshire Street
Marylebone, London W1G 7AF
Transport
Great Portland Street tube (2 min) · Regent's Park (4 min) · Marylebone mainline (7 min)
Heathrow
Elizabeth line direct to Bond Street, then 6 min walk
St Pancras
Direct from Eurostar — 12 min by taxi or Bakerloo line

Book directly via HCA

Same-week appointments are routinely available for both new patients and second-opinion referrals. International patients can request a pre-consultation imaging review via the private office before travel.

Book at HCA Princess Grace →

How to get in touch

Patients and referring clinicians can reach the private office directly. No GP letter is required for a private consultation, although insurers typically require one to authorise treatment under your policy.

01 · Online
Book via Carebit
Same-week appointments at Princess Grace, Marylebone. Available 24/7 — no need to call during office hours.
Book online →
02 · Telephone
Call the private office
Chloe & Bradley Barker manage the private secretary function. Available Monday to Friday, 9am–5pm.
020 3488 4777
03 · Email · Imaging review
Send investigations ahead
For tertiary referrals, email imaging reports, biopsy results, and clinical summaries to the private office. Pre-consultation review is possible — particularly useful for international patients.
privateoffice@dsri.co.uk

Going deeper

For full clinical and procedural information, the dedicated information pages are below.

Condition overview
Kidney cancer — diagnosis, staging, and treatment options
RCC vs UTUC, the EAU treatment pathway, the case for nephron preservation, and how decisions are made in an MDT setting.
Kidney cancer overview →
Procedure detail
Robotic partial nephrectomy — London
The procedure in detail, the retroperitoneal approach, complexity case mix, recovery timelines, and what to expect at Princess Grace.
Partial nephrectomy London →
Second opinion · all cases
Tertiary & second opinion referrals
Detail on prostate cancer second opinions, kidney cancer tertiary referrals, and how this practice receives complex cases from across the UK.
Second opinion & referrals →

Frequently asked questions

Logistics-focused questions for patients seeking a second opinion or tertiary referral. Clinical FAQs about kidney cancer itself are answered on the kidney cancer page.

Before agreeing to radical nephrectomy, a specialist second opinion at a high-volume nephron-sparing centre is strongly recommended. Many patients are found to be candidates for kidney-preserving surgery on review. The conversion rate from planned partial to radical nephrectomy in Mr Sri's series is 0.3% — meaning the kidney is preserved in virtually every case where partial surgery has been planned. Send your imaging report and clinical summary ahead via privateoffice@dsri.co.uk to enable an informed first consultation.

Yes — particularly for international patients and those travelling significant distances within the UK. CT or MRI imaging on disc, with the original radiology report, can be sent to the private office for review. This is a chargeable service and does not replace a full consultation, but it allows informed conversation about whether travel for in-person assessment is likely to lead to a different treatment plan.

HCA Princess Grace has an established international patient pathway: concierge service, interpreter support, proximity to West End hotels, and straightforward access from Heathrow (Elizabeth line direct to Bond Street, 6 minutes from the hospital) and St Pancras (direct from Eurostar). The hospital's international patient office handles travel-related logistics. From a clinical perspective, sending imaging ahead allows pre-consultation review and pre-planning of the treatment pathway, including the availability of pre-operative assessment and same-trip surgery where appropriate.

No — you can self-refer directly via Carebit, telephone, or email. Many patients self-refer for a second opinion having been seen elsewhere. However, most insurers require a GP referral letter to authorise treatment under your policy — check with your insurer. For self-pay patients, no GP letter is needed at any stage.

Yes. Mr Sri also consults and operates at Spire St Anthony's Hospital (Cheam, Surrey), Nuffield Health Parkside (Wimbledon), and Kingston Private Health (Kingston Hospital). For Central or North London, international patients, or those wanting the Marylebone/Harley Street setting, Princess Grace is typically the natural choice. For South West London or Surrey patients, the other locations are often more convenient. The same surgical standards apply across all sites.

All major UK private health insurers including Bupa, AXA, Vitality, Aviva, Cigna, WPA, and Healix. International insurers and self-pay patients are also welcome at Princess Grace. The HCA international patient office can advise on pre-authorisation for international medical insurance.

Mr Denosshan Sri
MA Cantab  |  MB BChir  |  FRCS Urol  |  Consultant Urological Surgeon
Mr Sri is Kidney Cancer Lead for the South West London Network at St George's University Hospital — the formal NHS tertiary referral consultant for complex kidney cancer cases across the region. His subspecialty is nephron-sparing surgery, including the retroperitoneal robotic approach which he introduced to South West London. He is Principal Investigator for South West London on the PARTIAL randomised controlled trial (robotic partial vs radical nephrectomy in high-risk renal tumours). Quaternary referrals from across the UK and internationally are accepted at HCA Princess Grace Hospital, Marylebone.

Reconsidering kidney surgery? A specialist opinion is always worth having.

Same-week appointments at HCA Princess Grace, Marylebone. Self-referral, tertiary referrals, and international patients all welcome. Pre-consultation imaging review available for those travelling.