Open Radical Nephrectomy: 35 Years of Experience at the “Luciano Giuliani” Urological Department of the University of Genoa

Carmignani, G.; Simonato, Alchiede; Corbu, C.; Traverso, Paolo; Ruggiero, Gabriele; Pizzorno, R.; Vota, Paolo; Martorana, Giuseppe; Belgrano, E.; Romagnoli, Andrea

doi:10.1016/j.eursup.2006.03.009

Cited by 1 publication

(2 citation statements)

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“…RN has a 30-day mortality of 0.5-1.8% (40)(41)(42)(43)(44). Perioperative mortality is associated with increasing tumour stage, ranging from 0.3% in T1-2 tumours to 1.3% in T3-4 tumours, and varies inversely with increasing surgeon and hospital operative volume (41,43).…”

Section: Peri-operative Morbiditymentioning

confidence: 99%

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The role of open radical nephrectomy in contemporary management of renal cell carcinoma

Kalapara¹,

Frydenberg²

2020

Transl Androl Urol

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Radical nephrectomy (RN) remains a cornerstone of the management of localised renal cell carcinoma (RCC). RN involves the en bloc removal of the kidney along with perinephric fat enclosed within Gerota's fascia. Key principles of open RN include appropriate incision for adequate exposure, dissection and visualisation of the renal hilum, and early ligation of the renal artery and subsequently renal vein. Regional lymph node dissection (LND) facilitates local staging but its therapeutic role remains controversial. LND is recommended in patients with high risk clinically localised disease, but its benefit in low risk node-negative and clinically node-positive patients is unclear. Concomitant adrenalectomy should be reserved for patients with large tumours with radiographic evidence of adrenal involvement. Despite a recent downtrend in utilisation of open RN due to nephron-sparing and minimally invasive alternatives, there remains a vital role for open RN in the management of RCC in three domains. Firstly, open RN is important to the management of large, complex tumours which would be at high risk of complications if treated with partial nephrectomy (PN). Secondly, open RN plays a crucial role in cytoreductive nephrectomy (CN) for metastatic RCC, in which the laparoscopic approach achieves similar results but is associated with a high reoperation rate. Finally, open RN is the current standard of care in the management of inferior vena caval (IVC) tumour thrombus.Management of tumour thrombus requires a multidisciplinary approach and varies with cranial extent of thrombus. Higher level thrombus may require hepatic mobilisation and circulatory support, whilst the presence of bland thrombus may warrant post-operative filter insertion or ligation of the IVC.

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Section: Peri-operative Morbiditymentioning

confidence: 99%

“…Stage T3-4 tumours and Charlson Comorbidity Index greater than 2 are both independently associated with greater risk of grade 3-4 Clavien complications (45). Rates of blood transfusion range between 10-11% (40,44). Splenic injury during is a rare but known complication of left RN and occurs in 0.8% of cases (46).…”

Section: Peri-operative Morbiditymentioning

confidence: 99%

The role of open radical nephrectomy in contemporary management of renal cell carcinoma

Kalapara¹,

Frydenberg²

2020

Transl Androl Urol

View full text Add to dashboard Cite

show abstract

Open Radical Nephrectomy: 35 Years of Experience at the “Luciano Giuliani” Urological Department of the University of Genoa

Cited by 1 publication

References 20 publications

The role of open radical nephrectomy in contemporary management of renal cell carcinoma

The role of open radical nephrectomy in contemporary management of renal cell carcinoma

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