title: Coloepiploic mobilization during left radical nephrectomy for renal cell carcinoma is indicated to reduce the risk of iatrogenic splenectomy.
abstract: OBJECTIVE
  To determine whether coloepiploic mobilization (CEM) is indicated to reduce the incidence of iatrogenic splenectomy during left radical nephrectomy for renal cell carcinoma. The incidence of iatrogenic splenectomy during a left nephrectomy is estimated to be between 1.4% and 24%. In a recent study, we reported that the incidence of iatrogenic splenectomy was 8% during a left nephrectomy performed for renal cell carcinoma through a transperitoneal anterior subcostal incision.
  
  
  METHODS
  A left radical nephrectomy was performed in 233 consecutive patients for renal cell carcinoma through a transperitoneal anterior subcostal incision with a CEM procedure in which the left colonic flexure was completely detached from the epiploa. Perioperative and postoperative complications, including splenic injury, were noted in a database. The mean patient age was 51.3 years (range 21.3 to 90.2). The mean tumor size was 58 mm (range 15 to 230).
  
  
  RESULTS
  An iatrogenic splenectomy was required in 3 patients, and in 1 patient, a splenic injury was treated conservatively. The incidence of iatrogenic splenectomy accompanying left radical nephrectomy was 1.3%. The mean operative time was 120 minutes (range 80 to 240). The mean time to normal gut motility was 3.4 days (range 2 to 11) and to discharge from the hospital it was 9.3 days (range 6 to 19). Regarding CEM, we did not observe any significant abdominal complications.
  
  
  CONCLUSIONS
  The incidence of iatrogenic splenectomy during a left radical nephrectomy through a transperitoneal anterior subcostal incision may be reduced by performing the technique of CEM.
authors.affiliation: Department of Urology, Hôpital Necker, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Mejean
authors.forename: Yves
authors.initials: Y
authors.lastname: Chretien
authors.forename: Benoit
authors.initials: B
authors.lastname: Vogt
authors.forename: Sebastien
authors.initials: S
authors.lastname: Cazin
authors.forename: Chant
authors.initials: C
authors.lastname: Balian
authors.forename: Nicolas
authors.initials: N
authors.lastname: Thiounn
authors.forename: Bertrand
authors.initials: B
authors.lastname: Dufour
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D003106:Colon; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology / Q000517:prevention & control*; D007431:Intraoperative Complications / Q000517:prevention & control; D007680:Kidney Neoplasms / Q000601:surgery*; D007902:Length of Stay; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D009852:Omentum; D013154:Spleen / Q000293:injuries; D013156:Splenectomy