1987 Volume 78 Issue 8 Pages 1394-1402
A clinico-statistical study was made on surgical operations performed in a total of 333 cases that were encountered over the period of 18 years from January 1965 through December 1982. The conclusion drawn from this study may be summarized as follows:
1) Nephrectomy was performed in 284 (85%) and not performed in 42 (13%) of the 333 cases. In 7 cases (2%) the operation was unsuccessful, ending in failure to excise the organ for various reasons including adhesions of the organ. There were 6 operative deaths (2%). 2) Translumbar nephrectomy was performed in 87 (31%), transperitoneal nephrectomy in 172 (61%), thoracoabdominal nephrectomy in 22 (8%) and partial nephrectomy in 3 cases (1%). No significant difference existed in long-term results between patients undergoing translumbar and those undergoing transperitoneal nephrectomy, suggesting that a transperitoneal approach is not invariably nessary and that translumbar operation may suffice in some cases. 3) In 10 cases (3%) there was lymph node involvement of N1 Mo or N2 Mo, and it was ipsilateral in all cases. This has led us to believe in the validity of lymphnode dissection performed on the affected side alone. 4) In 42 cases (13%) there was invasion of the renal vein or inferior vena cava. This incidence figure is much lower than most of those reported previously, presumably because of our inadvertency in examining the organs resected. 5) Only 3% of the total tumors studied were what may reasonably be considered early tumors less than 3cm in diameter. Staging according to Robson's criteria showed that the tumor was 5cm or longer in diameter in the majority (74%) of stage I cases, contrary to the prevailing notion that stage I is tantamount to early cancer. It appears, therefore, that Robson's classification system is not appropriate for the staging of renal cell carcinoma.
