Mortality and Morbidity after Nephrectomy for Renal Cell Carcinoma Using a Transperitoneal Anterior Subcostal Incision

Méjean, Arnaud; Vogt, B; Quazza, Jean Emile; Chrétien, Yves; Dufour, B

doi:10.1159/000020008

Cited by 44 publications

(24 citation statements)

References 7 publications

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“…Pancreatectomy and vascular surgery of the suprarenal abdominal aorta are other, common occasions of associated splenectomy [2,4].…”

Section: Discussionmentioning

confidence: 99%

“…In particular, left radical nephrectomy has been reported as the second most common cause of incidental splenectomy [1][2][3]. Although splenectomy is often regarded as only an inconvenience to the surgeon, it can be the source of troublesome complications for the patient and can considerably increase post- operative morbidity [2,[4][5][6]. Reports on the intraoperative factors leading to spleen injury and how to avoid them are rleatively rare [2].…”

Section: Introductionmentioning

confidence: 99%

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Incidental Splenectomy during Left Radical Nephrectomy: Reasons and Ways to Avoid It

2001

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Introduction: Left radical nephrectomy is the second most common cause of incidental splenectomy during transabdominal oncological surgery in the upper left quadrant of the abdomen. The potential sequelae of splenic ablation are often underestimated and generally no systematic planned efforts have been undertaken to avoid a splenic injury. Material and Methods: We evaluated the incidence of iatrogenic splenectomy in 333 cases of left radical nephrectomy for renal cancer performed at our institute between 1970 and 1999. Two slightly different surgical techniques were adopted and after 1995 particular attention was paid to the possible causes of intraoperative splenic injury and how to avoid it. In the first group of patients (1970–1994) an anterolateral xipho-umbilical-subcostal approach was used, and in the second group (1995–1999) a cruciate ‘Mercedes-like’ incision was always adopted. Results: The incidence of iatrogenic splenectomy in the first group of patients was 13.2%, and only 2.6% in the second group. The mortality rate in the first group of patients was 6%; no mortality has been recorded in the second group. Postoperative infections averaged 12.1% in the first group and 11.6% in the second, without any difference between the two groups. However, if we consider the incidence of postoperative infections in splenectomy cases, the incidence reaches 24.2% in the first group versus no cases in the second. Conclusions: Incidental splenectomy is a potentially severe complication of transabdominal left radical nephrectomy and is often considered a price that has to be paid, particularly in cases of large tumoral masses. A more detailed knowledge of splenic anatomy, a critical consideration of the intraoperative factors that may lead to splenectomy, and the adoption of a surgical tactic borrowed from the techniques of liver transplant significantly lower the incidence of iatrogenic splenectomy.

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“…Pancreatectomy and vascular surgery of the suprarenal abdominal aorta are other, common occasions of associated splenectomy [2,4].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidental Splenectomy during Left Radical Nephrectomy: Reasons and Ways to Avoid It

2001

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“…This can be achieved by having an adequate incision. Various types of incision have been described to optimise the exposure during left nephrectomy [1,4,5,7,[17][18][19][20]. Carmignani et al [17] compared two different types of incision used; namely the anterolateral transabdominal approach involving a xipho-umbilical-subcostal flap and the cruciate Mercedes incision.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Splenectomy during Left Nephrectomy: A Single-Institution Experience of Eight Years

et al. 2011

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Introduction: Iatrogenic injury to the spleen is not an uncommon complication. Left nephrectomy has been reported as the second commonest cause of iatrogenic splenectomy with a reported incidence between 1.3 and 24%. Iatrogenic splenectomy is associated with significant morbidity and mortality. Aims: We reviewed the occurrence of iatrogenic splenectomy during left nephrectomy at our centre. Our aims were to determine the incidence of iatrogenic splenectomy within the Mid Yorkshire Hospitals NHS Trust in order to understand the nature of the splenic injury and the morbidity and mortality associated with it. Methods: All splenectomy and nephrectomy histology reports from January 2000 to December 2007 were reviewed retrospectively. Indications for splenectomy and nephrectomy were identified. Patients’ demographic data, tumour characteristics, operative details, length of hospital stay and any reported morbidity or mortality were collected. Results: A total of 447 nephrectomies were identified which included 234 left nephrectomies. Within the same period 136 cases of splenectomy were performed. Thirty-four cases were iatrogenic splenectomies and 12 were caused by left nephrectomy. The incidence was 5.13%. The male to female ratio was 1:1 with an average age of 66 years. Grade 2 and stage pT2 renal cancer were the commonest tumour characteristics. All iatrogenic injuries occurred during mobilisation of the colon or division of adhesion. The average operative time was 4.7 h. Average length of hospital stay was 14 days. Five patients had postoperative complications and 1 died of respiratory failure and sepsis. Conclusion: Splenic injury during left nephrectomy is a morbid complication. A good understanding of anatomy and surgical approach may reduce the incidence, morbidity and mortality of iatrogenic splenectomy during left nephrectomy.

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“…Multiple different techniques have been reported for performing removal of renal cell tumours with tumour thrombus extension into the IVC. 13 Use of CPB with DHCA appears to be the safest way to facilitate complete resection of the kidney and tumour thrombus, and repair the IVC in a bloodless environment, to minimize blood loss. 12,[14][15][16] Less invasive methods to avoid DHCA and aortic cross clamping include removing the tumour fragments with either a fibrillating or beating heart.…”

Section: éLéments Cliniques : Un Homme De 47 Ans Témoin De Jéhovah mentioning

confidence: 99%

Multidisciplinary management of a Jehovah’s Witness patient for the removal of a renal cell carcinoma extending into the right atrium

Moskowitz

Perelman

Cousineau

et al. 2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To highlight the management of a Jehovah's witness surgical patient presenting for cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest. C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 47-yr-old male, Jehovah's Witness, with renal cell carcinoma was admitted for left radical nephrectomy and excision of tumour thrombus extending into the junction of the inferior vena cava (IVC) and right atrium (RA). The preoperative goals were to maximize red blood cell mass, delineate the extent of tumour extension and develop a surgical plan incorporating blood conservation strategies to minimize blood loss. A midline abdominal incision was made to optimize removal of the non-caval portion of the tumour from the intra-abdominal region. CPB and deep hypothermic circulatory arrest were instituted to aid in removing the tumour from the IVC and RA. Intraoperative blood conservation strategies included the use of acute normovolemic hemodilution, antifibrinolytics, cell salvage, point-of-care monitoring of heparin and protamine blood concentrations, leukocyte-depleting filter, and meticulous surgical techniques. The patient was successfully weaned from CPB and was transported to the cardiothoracic intensive care unit without complication. The patient was discharged home one week after the operation with a hemoglobin of 10.2 g·dL -1 and a hematocrit of 31.2%.

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Mortality and Morbidity after Nephrectomy for Renal Cell Carcinoma Using a Transperitoneal Anterior Subcostal Incision

Cited by 44 publications

References 7 publications

Incidental Splenectomy during Left Radical Nephrectomy: Reasons and Ways to Avoid It

Incidental Splenectomy during Left Radical Nephrectomy: Reasons and Ways to Avoid It

Iatrogenic Splenectomy during Left Nephrectomy: A Single-Institution Experience of Eight Years

Multidisciplinary management of a Jehovah’s Witness patient for the removal of a renal cell carcinoma extending into the right atrium

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