TRANSPERITONEAL APPROACH FOR RADICAL NEPHRECTOMY: FIVE YEARS EXPERIENCE AT PAKISTN INSTITUTE OF MEDICAL SCIENCES, ISLAMABAD, PAKISTAN.
AbstractBackground: Renal cell carcinoma (RCC) comprises 85% of all renal neoplasms. Radicalnephrectomy is the only hope of cure for patients with RCC. Role of chemotherapy andradiotherapy is very limited because of the chemo -radio resistant nature of these tumours. Severalsurgical approaches have been employed depending upon surgeon preference, size and location ofthe tumour. Objective of this study is to share the five years experience (from 1999 to 2004) ofradical nephrectomy at Urology Department, Pakistan Institute of Medical Sciences (PIMS), thatwas performed through anterior sub costal trans-peritoneal incision. Methods: It was a descriptivetype of study with convenient non probability sampling technique. 100 patients were included.Patients were assessed by their mode of presentation, laboratory investigations, intra-operativefindings, control of renal pedicle, total operative time, blood loss, intra-operative and postoperative complications. The observations were noted on a proforma and analysed on SPSSversion 10. Results: Out of 100 patients, 64% were male and 36% were female with mean age of58 years. Most common presentation was pain, present in 60% of patients. 88% of patients hadnormal renal function test. Average tumour size was 7.93cm, diagnosed on ultrasonography(USG) and CT scan. Average time taken to get control of renal pedicle was 73.2minutes. 20% ofpatients needed venacavatomy and thrombectomy, which was easier through this approach. Meanoperative time was 129.44 minutes. Average blood loss was 274.2ml. No intra -operativecomplications were seen. Mortality rate was 4%. Conclusion: Radical nephrectomy is still thebest option for treatment of renal cell carcinoma. There are various surgical approaches, however,anterior subcostal transperitoneal approach is more effective with early control of renal pedicle,less blood loss and minimal manipulation of the kidney thus minimizing the risk of embolism.Keywords: Radical nephrectomy; Anterior subcostal; Transperitoneal.
Dreicer R, Williams RD. Renal Parenchymal Neoplasms. In:
Tanagho EA, Mc Aninch JW. Swiss General Urology. 15 th
ed. New York: Mc Graw Hill, 2000; 378-98.
Motzer RJ, Bander NH, Nanus DM, Renal-cell carcinoma. N
Engl J Med. 1996; 335(12): 865-875.
Robson CJ. Radical Nephrectomy for renal cell carcinoma. J
Urol 1963; 89:37-42
Amanullah, Saleem MA, Khan JH, Khan FA. Clinical
presentation of renal cell carcinoma. Bio Medica 1999;15: 9.
Eggener SE, Rubenstein JN, Smith ND, Nadler RB, Kontak
J, Flanigan RC et al. Renal tumour in young adults. J Urol
Khauli RB, Ei-Hont Y, Medi R. Trends in the management of
renal cell carcinoma. Annals 2003;5:48.
Kageyama Y,Fukui I, Goto S,Kitahara S,Kamai T,Suzuki T,
Oshima H. Treatment results of radical nephrectomy for
relatively confined small renal cell carcinoma--- translumbar
versus transabdominal approach. Nippon Hinyokika Gakkai
Suggs WD, Smith RB 3rd, Dodson TF, Salam AA, Graham
SD Jr. Renal cell carcinoma with inferior venacaval
involvement. J Vasc Surg 1991;14(3):413-18.
O’Donohoe MK, Flanagan F, Fitzpatrick JM, Smith JM.
Surgical approach to inferior vena caval extension of renal
carcinoma. Br J Urol 1987;60(6): 492-6.
Mejean A, Vogt B, Quazza JE, Chretien Y, Dufour B.
Mortality and morbidity after nephrectomy for renal cell
carcinoma using transperitoneal anterior subcostal incision.
Eur Urol1999; 36(4):298-302.
Herranz Amo F, Verdú Tartajo F, Díez Cordero JM,
Rodríguez Fernández E, Lledó García E, Moncada Iribarren I
et al. Complications of radical nephrectomy in the treatment
of kidney adenocarcinoma. Actas Urol Esp 1997; 21(1):15.
Répássy DL, Bécsi A, Tamás G, Weninger T. Comparison of
morbidity of lumbar flank approach and transperitoneal
approach for radical nephrectomy. Acta Chir Hung 1999;
Janetschek G, Jeschke K, Peschel R, Strohmeyer D, Henning
K, Bartsch G. Laparoscopic surgery for stage T1 renal cell
carcinoma: radical nephrectomy and wedge resection. Eur
Urol 2000; 38:131-8.
Stephenson AJ, Hakimi AA, Snyder ME, Russo P.
Complications of radical and partial nephrectomy in a large
contemporary cohart. J Urol 2004; 171(1): 130-4.
Rassweiler J, Frede T, Henkel TO, Stock C, Alken P.
Nephrectomy: A comparative study between the
transperitoneal and retroperitoneal laparoscopic versus the
open approach. Eur Urol 1998; 33(5):489-96.