THORACOABDOMINAL RADICAL NEPHRECTOMY FOR RENAL CELL CALCINOMA

Abstract

During the 4 year period from October 1979 to September 1983, thoracoabdominal radical nephrectomy was performed in 22 cases of renal cell carcinoma. With patients in semi-recumbent position of 30 degree angle an incision was made at the level of the 8th or 9th rib to the midline just above the umbilicus.
The 8th or 9th rib was resected, and the rib bed was incised to enter the thoracic cavity. Then the diaphragm was opened to enter the peritoneal cavity to perform radical nephrectomy. In all cases lymphadenctomy was performed. The mean operating time for the whole 22 cases was 285 minutes with a mean blood loss of 983ml. However, the mean operating time for 16 cases without additional surgical procedure and intraoperative complication was 254 minutes with a mean blood loss of 742ml. No postoperative death occurred. The only intraoperative complication was vascular injury which was observed in 2 cases (or 9.1%). The incidence of postoperative complication was also as low as 2 cases (or 9.1%).
In one case exacerbation of preexisting renal failure was seen, while in the other case strong pain of the operative wound was noted. In both cases alleviation was obtained by conservative therapy. In none of the cases pulmonary complication was observed. This approach is the best operative method for renal cell carcinoma, especially in cases of large and upper pole tumor advancing to the subdiaphragm.