A Clinical Experience of Radical Nephrectomy by Modified Thoracoabdominal Approach in Patients with Renal Cell Carcinoma

Lee, Young Tae; Lee, Jin Moo

Abstract

45 cases of proved renal cell carcinoma which were operated on during last 10 years between March 1972 and February 1982 in the department of Urology of Yonsei University College of Medicine were clinically observed with the reference to the operative morbidity due to the surgical incisions of both anterior transperitoneal approach (25 cases or 55%) and modified thoracoabdominal approach which is 11th-rib resection with extrapleural and transperitoneal exposure (20 cases of 45%). According to the experience with modified thoracoabdominal incision for the 17 radical nephrectomies and 3 open biopsies and through the review of the literatures, some results were obtained and summarized as follows. 1. Modified Thoracoabdominal approach is superior to the anterior transperitoneal approach for the operation of renal malignancy because of better exposure for the renal pedicle and upper pole as well as low morbidity rate (1:1.6). 2.We could also be sure by our self experiences of a few advantages of Modified Thoracoabdominal approaches as others reported previously. (1) An undisturbed intrathoracic space avoids a source of complications. (2) Because of adequate exposure of renal pedicle and upper pole even in the large renal tumor, operativemanipulation is easier and safer. (3) As muscle layers to be cut are not heavy, postoperative pain is less complained. The incision is also relatively simple to make and close. (4) Modified Thoracoabdominal approach is worth to apply to any urologic operations for the kidney and upper ureter. 3. In case tumor thrombi were involved in the supradiaphragmatic vena cava and vena caval resection is inevitable, either midline abdominal incision with sternotomy or conventional thoracoabdominal incision should be chosen rather than Modified thoracoabdominal approach.