title: Mortality and morbidity after nephrectomy for renal cell carcinoma using a transperitoneal anterior subcostal incision.
abstract: OBJECTIVE
  We have reviewed our surgical experience to document intra- and postoperative mortality and morbidity in 656 patients with renal cell carcinoma who underwent nephrectomy through a transperitoneal anterior subcostal incision (TASI).
  
  
  METHODS
  From 1986 to 1997 we performed 656 nephrectomies for renal cell carcinoma using a TASI. Details of the surgical procedure are presented together with a retrospective analysis of the postoperative data concerning both the patient and the complications related to this approach.
  
  
  RESULTS
  The mean time of operation was 130 min and the mean discharge from hospital 11 days. An additional surgical procedure in relation with the cancer facilitated by this approach was necessary in 2.1% of cases. The rates of intra- and postoperative complications were respectively 6.4 and 29.7%. The rate of intestinal complications was 1.8% and a splenic injury occurred in 8% of left nephrectomy. The mortality rate was 0.6%.
  
  
  CONCLUSIONS
  The TASI is a large convenient incision which allows safe control of the renal pedicle in a very large number of renal tumors, even those located in the upper pole of the kidney. The rate of gut complications is very acceptable. Splenic injury is the major problem during left nephrectomy but careful dissection and surgical experience could decrease this complication, especially in case of upper pole renal tumor. We consider the TASI to be the main radical nephrectomy incision for renal cell carcinoma.
authors.affiliation: Department of Urology, Hôpital Necker, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Mejean
authors.forename: B
authors.initials: B
authors.lastname: Vogt
authors.forename: J E
authors.initials: JE
authors.lastname: Quazza
authors.forename: Y
authors.initials: Y
authors.lastname: Chretien
authors.forename: B
authors.initials: B
authors.lastname: Dufour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007422:Intestines / Q000293:injuries; D007431:Intraoperative Complications; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D011183:Postoperative Complications; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries; D013156:Splenectomy; D013997:Time Factors; D016896:Treatment Outcome