RADICAL NEPHRECTOMY FOR RENAL CELL CARCINOMA

Operative Approach

Abstract

We reviewed the operative results, and intra- and postoperative complications of 85 renal cancer patients treated by nephrectomy at our clinic during the 18 year period from March 1986 to December 1985.
1) The operation time was shortest in flank incision, and longest in unilateral subcostal incision.
2) In transperitoneal approach, unilateral subcostal incision resulted in less intraoperative blood loss than others.
3) Preoperative renal artery embolization decreased intraoperative blood loss in patients treated by flank incision. However, in patients treated by transperitoneal approach, no difference was seen either in the required operation time or the intraoperative blood loss between patients with and without embolization.
4) Retroperitoneal lymphadencetomy caused a prolongation of 105 minutes in operation time and an increase of 72ml in intraoperative blood loss.
5) Intraoperative complications occurred in 16 patients (19%), they were seen most frequently in the midline upper abdominal incision. And the commonest complication was splenic damage, which occurred in 8 patients. However, no intraoperative complications were caused by retroperitoneal lymphadenectomy.
6) Postoperative complications were seen frequently in flank and paramedian incision. In unilateral subcostal incision, only two patients (6%) were afflicted with wound pain. In patients with acute pancreatitis and lymphrrhea, the cause was probably due to retroperitoneal lymphadenectomy.
Therefore, unilateral subcostal incision seems to be a useful approach for radical nephrectomy.