title: Combined nephrectomy and major hepatectomy: indications, outcomes, and recommendations.
abstract: BACKGROUND
  Simultaneous nephrectomy with major hepatectomy (NMH) is uncommon. We reviewed our experience with NMH.
  
  
  METHODS
  Records of patients who underwent NMH at Emory Hospital between January 1995 and May 2008 were examined. Patients undergoing resection of three or more liver segments at the same setting as a total nephrectomy were included. Indications and outcomes were assessed.
  
  
  RESULTS
  Twenty patients underwent NMH. Mean (+/- SD) age was 59.9+/-12.8 years, 6 (30%) were women, and 15 (75%) presented with comorbidities. Most kidney neoplasms were renal cell carcinomas of the right kidney (n=16, 80%) with a mean diameter of 10.0+/-6.1 cm. Eight patients (40%) also underwent thrombectomy for inferior vena cava tumor thrombus. The most common indications for hepatectomy were direct liver invasion in eight patients (40%) and distant hepatic metastases in nine (45%); liver tumors were 4.2+/-3.3 cm (mean +/- SD) in diameter. Mean (+/- SD) operative time was 8.3+/-2.6 hours. Liver resections included 15 (75%) right hepatectomies and 5 (25%) left hepatectomies. In all cases, tumor negative hepatic margins were achieved. Median operative blood loss was 1,700 mL (range 200 to 8,000 mL). Ten patients (50%) suffered complications in the postoperative period; three of these suffered major complications, resulting in one perioperative death (5%). Mean hospital stay was 12+/-8.8 days. Overall survival was 25 months (range 0 to 34 months).
  
  
  CONCLUSIONS
  In this large series of nephrectomy with simultaneous major hepatectomy, morbidity and mortality were acceptable. In specialized centers NMH may be considered in properly selected patients for combined resection for synchronous neoplasms of the kidney and liver.
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA.
authors.forename: Maksym
authors.initials: M
authors.lastname: Yezhelyev
authors.forename: Viraj
authors.initials: V
authors.lastname: Master
authors.forename: Vasili
authors.initials: V
authors.lastname: Egnatashvili
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby