Nephrectomy - Science method

Thank you Ahmed. The question was about posterior retroperitoneoscopic kidney tumour resection. I noticed there has been one in literature (back in 2006) for a tumour in the posterior surface of the kidney. I did use this procedure today for a tumour in the anterior surface of the kidney, went good.

Thomas Monaghan how do I get into the twitter forum?

Thank you for this answer. Ill read it.

François

The usual mechanism of hypertension after uninephrectomy is glomerular damage by overload of the glomeruli of the remaining single kidney.

In ureteral duplication the upper pole ureter often inserts ectopically into the bladder or surrounding tissues, and it can be obstructed. The lower pole ureter can have reflux, which can contribute to incomplete bladder emptying. (Of course either can have reflux or obstruction but the above is the more common scenario). If she has pain from the obstruction, if the obstructed pole is infected, or if she has difficult to control hypertension, then I would consider surgery; however, I would hesitate to subject her to the risks of surgery and anesthesia otherwise.

This might help you.......

Though sunitinib affects wound healing, the range of time to start it after nephrectomy is 14-80 days. On the other hand you can do nephrectomy post target therapy after a time range of 7-21 days.

Just saw the patient 2 weeks post-OP.

He is doing well. Due to the inability to resect the complete hernia sac from inside, he developed a subcutaneous seroma. We will wait until it has resolved. beside that he is doing great and back to his normal life activity.

Dear Alireza,

I don't think I would agree with Dr.Theodor Klots, with regards to the timing of RAE.

One week is too early-ideally it is done just a day before surgery-sometimes even hours before.You want to operate before tumor lysis syndrome kicks in. Also, the longer one waits, the more edema and destruction of surgical planes is there, especially at the hilum.

In fact, there are a few papers, where a balloon catheter is threaded unto the renal artery, in the OR suite, and then left in. After opening, the balloon is inflated, to occlude the arterial inflow, in larger tumors, before ligating the renal artery.

One of the major problems during nephrectomies for very large vascular tumors, is the "venous hypertension"-especially in the presence of tumor thrombus or large collaterals.

Using RAE just prior to surgery, in that setting is useful.

Depending on the features of the patients who are transplanted (ie age and underlying disease), the incidence is between 0.5-1.0%. Here is the link to one large published series (there are other reports in the literature)-

If there is no sign of metastatic disease I am not sure you have to make significant adjustments to the immunosuppression at this stage. Management of metastatic disease should be multidisciplinary with input from an Oncologist.

I think that its better to do nephrectomy. It is necesary to know before the renal function oft he other kidney

Even in the absence of strong evidence most centers followed the same strategy. The decision in our center generally depends on patients performance status, the spread of distant disease and the presence of symptoms from the primary tumor. We offer nephrectomy to fit patients with bulky/symptomatic tumors and/or limited distant disease, targeting improvement of QOL and reduced total tumor volume. However it is not clear whether this policy is beneficial, excluding two points: improved QOL in pts with bulky/symptomatic tumors and psychological benefit for most of the patients when the primary is removed.

In such cases we do left upper compartment resection which usually requires en block removal of the lesion along with distal splenopacreatectomy and adrenalectomy. Regarding the lefrt kidney it can be usually preserved and only fatty capsule can be removed if there is not direct infiltration of the kidney. Sometimes resection of the diaphragm and lumbar musculature is also needed to achive R0.

As distant lesions are small we will also discuss with thoracic surgeons the possibility for video-assisted thoracoscopic resection at second stage. And adjuvant treatment depends on final histology.