ABSTRACT
Objective: To share the experience of radical nephrectomy through transperitoneal approach
Material and methods: After approval from ethical committee and the consent from patients a retrospective study vas conducted extending from January 2012 to January 2014 to identify clinical characteristics of renal ell carcinomas, staging, per operative and early post operative complications. The study included all renal cancer patients presented to Sheikh Zayed Hospital Lahore with in this specified period. Detailed history nd physical examination was performed. Haematological and radiological investigations including ibdominopelvic ultrasonography and CT scan abdomen and pelvis were performed to stage the renal umour. High resolution CT chest was performed where indicated. Radical nephrectomy performed hrough transabdominal approach and outcomes measured in terms of per-operative and early postoperative complications
Results: There were total of 50 cases. The male to female ratio was 3:2. Vlean age of patients was 52.38 [18-93] years. Most common clinical presentation was gross haematuria [66%]. The mean tumour size was 8.34 [3-24] cm. Operative findings were suggestive of tumor limited to Gerota's fascia in 40 patients [80%] and in 6 [12%] tumor was extending into renal vein or inferior vena cava. In these cases, venacavatomy had to be performed. Lymphadenectomy was performed in 2 patients [4%] who were having enlarged hilar lymph nodes. Total operative time ranged between 120 to 180 minutes. Intra-operative splenic injury was seen in 2 [4%], while aortic injury was observed in one [2%] patient. Post operatively one [2%] developed pulmonary embolism, 2 [4%] chest infection while 2 [4%] developed wound infection and 3 patients [6%] required blood transfusion. Tumour histology was clear cell in [84%], papillary transitional cell carcinoma [12%] and oncosytoma contributed 4%
Conclusion: We observed that large number of the patients presented with haematuria and most of them were male. Radical nephrectomy along-with removal of tumour thrombus is a valuable method for the treatment of renal cell carcinoma having tumour thrombus either in renal vein or inferior vena cava. Common pathological type was clear cell carcinoma