Transabdominal Radical Nephrectomy for Renal Cell Carcinoma: an Experience on 155 Patients

BACKGROUND OBJECTIVE: Renal cell carcinoma (RCC) is a common urologic malignant tumor. Radical nephrectomy is the major treatment for RCC. Approaching route selection, lymphadenectomy selection, and lymphadenectomy extension are debated. This study was to summarize our experience on transabdominal radical nephrectomy for RCC. METHODS: A total of 155 RCC patients were treated with radical nephrectomy and regional lymphadenectomy between Oct. 1999 and Dec. 2005 in Cancer Center of Sun Yat-sen University. The duration of operation, the amount of bleeding, the duration of postoperative hospitalization, complications, and survival rates of the patients were reviewed. RESULTS: No patient died during operation. The median duration of operation was 155 min (range, 60-360 min). The median amount of bleeding was 200 ml (range, 50-10 000 ml). Sixteen patients received RBC transfusion with a mean of 11.5 units (1 unit of RBC is extracted from 200 ml whole blood). In 23 (14.8%) patients, the amount of bleeding was more than 500 ml; 5 of the 23 patients underwent inferior vena cava thrombectomy, with median bleeding of 1 100 ml (range, 100-6 000 ml). The median duration of postoperative hospitalization was 15 days (range, 6-46 days). The intraoperative complications, treated intraoperatively without sequelae, included 2 cases of spleen injury, 1 case of inferior vena cava and duodenal injury, and 2 cases of vessel injury. The postoperative complications, cured conservatively, included 1 case of heart failure and 2 cases of incomplete ileus. The patients were followed up for 1-78.6 months, with a median of 20.0 months. The 1-, 3-, and 5-year overall survival rates were 93.2%, 84.1%, and 74.8%, respectively. The 1-year overall survival rates were 100% for stage Ⅰ and stage Ⅱ patients, 88.2% for stage Ⅲ, and 53.8% for stage Ⅳ. The 3-year overall survival rates were 89.7% for stage Ⅰ, 95.5% stage Ⅱ, 75.6% for stage Ⅲ, and 44.9% for stage Ⅳ. The 5-year overall survival rates were 89.7% for stage Ⅰ, 86.8% for stage Ⅱ, and 0% for stage Ⅳ. CONCLUSIONS: Radical nephrectomy via transperitoneal route, with benefits of early ligating the renal vessels and easy to perform lymphadenectomy, has certain effect on RCC with less severe complications. It may be a standard surgical procedure for RCC.