More recently, there has been renewed interest towards a mini-incision subcostal radical nephrectomy. In particular, with increasing MIS approaches in Urology, there is concern than open surgical skills are lacking. Open surgical skills are essential for the urologist in-training and in practice. In this abstract, the authors report their peri- and post-operative outcomes after a standardized mini-subcostal incision technique for open radical nephrectomy (RN) – in the hopes that with similar outcomes, it may be a bridge for surgical training in the future!
It should be noted that the senior author of the abstract, Dr. Russo, is a strong advocate against robotic surgery, and has made this well known.
This was a retrospective analysis of a prospectively maintained database of patients undergoing transperitoneal open RN utilizing a mini-subcostal incision (8-12cm) and standardized post-operative recovery pathway between January 2013 - May 2016. The standardized post-operative recovery pathway was listed on the poster and encompassed 2 post-operative days – expected discharge was POD #2.
A total of 196 patients with a median follow-up of 11 months (range 1-40) were available for analysis – as the focus was immediate peri-operative outcomes, this was sufficient follow-up.
The median age of patients was 59.4 years. Median tumor size was 7.7 cm (IQR=5-9.6) and 132 (67%) of patients were pT3 or greater. Hence, these are not small renal masses; in general, they were more advanced malignancies.
In terms of intra-operative measures, median EBL was 300 ml (IQR=100-575) and median duration of surgery was 129 min (IQR=102-151). Intraoperatively, 28 patients (14%) had at least one blood transfusion and 1 patient had an enterotomy. In terms of post-operative measures, median LOS was 1.5 days (range 1-18 days).
Postoperative complications were assessed - the early (<-= 30 days) complication rate for minor (Clavien I-II) and major (Clavien III-V) complications was 19.5% and 3%, respectively. The minor late (>30 days) complication rate was 2%. No patients experienced late major complications or surgically-related deaths in our cohort.
- They provided a chart of the main complications.
- Clavien III complications (early) were wound infection, pancreatic fistula, bowel perforation, renal failure, and intra-abdominal infection
- Clavien III late complication was pleural effusion
I would argue that laparoscopic radical nephrectomy, if feasible, is probably the most cost and time-effective management of these tumors – if technically feasible. However, head-to-hear comparisons are needed to flesh this out.
Presented by: Kyle A. Blum, New York City, NY
Co-Authors: Maria F. Becerra, Alejandro Sanchez, Mazyar Ghanaat, Renzo G. DiNatale, Mahyar Kashan, Shawn Mendonca, Brandon J. Manley, Nicole Benfante, A. Ari Hakimi, Paul Russo
Written by: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto, @tchandra_uromd at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA