[Experiences of open transperitoneal radical nephrectomy for large renal masses].
OBJECTIVE
To evaluate the effect of technical improvements of transperitoneal radical nephrectomy on the patients with large renal cell carcinoma.


METHODS
From May 2002 until May 2009, 45 patients with large (> 12 cm) renal cell carcinoma underwent transperitoneal radical nephrectomy. A subcostal incision was selected to expose the extraperitoneal area. The modified operative methods included exposing the operative field via a liver retractor and initially ligating renal artery to block the blood supply of kidney and tumor. The method of tumor-free tissue dissociation was applied. Hem-o-lock was employed for clipping so as to avoid hemorrhage. This modified technique was evaluated in respects of operating time, estimated blood loss, intra-operative complications, postoperative complications, length of hospital stay and pathological diagnoses.


RESULTS
The tumor diameter was from 12.2 cm to 28.3 cm with a mean of 14.5 cm. The mean operative time was (150 +/- 58) min and the average estimated blood loss (350 +/- 180) ml. Three cases received blood transfusion. The average length of hospital stay was (12 +/- 6) days. Three cases developed complications, including spleen injury in 2 and pancreatic injury in 1. The treatment modalities were splenectomy and resection of pancreatic tail respectively. The pathological diagnoses were all of renal cell carcinoma. The pathological stage included T(2)N(0 approximately 1)M(0 approximately 1)(n = 13), T(3)N(0 approximately 1)M(0 approximately 1)(n = 23), T(4)N(0 approximately 1)M(0 approximately 1)(n = 9). After a follow-up period of 3 - 63 months, 3 cases of tumor recurrence were found in primary renal clutch.


CONCLUSIONS
Improved radical nephrectomy is feasible for large renal cell carcinoma. And it can reduce the volume of blood loss and decrease the occurrence of complications.
Yao
Xu-dong
XD
Department of Urology, Fudan University Cancer Hospital, Shanghai 200032, China.
Ye
Ding-wei
DW
Zhang
Shi-lin
SL
Dai
Bo
B
Zhang
Hai-liang
HL
Shen
Yi-jun
YJ
Zhu
Yao
Y
Zhu
Yi-ping
YP
Shi
Guo-hai
GH
Ma
Chun-guang
CG
Xiao
Wen-jun
WJ
Qin
Xiao-jian
XJ
Lin
Guo-wen
GW
D034841:Abdominal Cavity / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult