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PubMed1991

[Immunological assessment after radical nephrectomy for renal cell carcinomas pre-treated with interferon-gamma].

Twenty two patients with renal cell carcinoma subjected to radical nephrectomy were divided into 2 groups, the first group consisted of 10 patients who received pre-operative interferon-gamma (IFN-gamma administered group), and the second one consisted of 10 patients who received nephrectomy alone (non-administered group). An immunological assessment was made as to whether the pre-operative administration of IFN-gamma affects the immunocompetent cells before or after nephrectomy with reference to stage or grade of cancer, the duration of anaesthesia and in the absence or presence of a blood transfusion. Immunocompetent cells that we had checked were peripheral blood lymphocytes (PBL), CD3, CD4, CD8, CD16 and CD20. These cells were examined on the day before the administration of IFN-gamma (in the case of the administered group), just before nephrectomy and on the 7th day after nephrectomy. With regard to the effects of the administration of IFN-gamma pre-operatively, there were more patients who showed an increase of CD16 in the administered group, compared with the patients who showed a decrease of CD16, and its difference was significant. On the other hand, we observed that the patients who showed an increase of CD16 were low stage and low grade predominantly, but the difference was not significant. Regarding the immunological changes after nephrectomy, there appeared to be an increase in the ratio of CD4/CD8 in the administered group, and these patients were low stage and low grade significantly. As to CD16, the tendency was similar to that observed for the ratio of CD4/CD8 in the administered group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1987

Role of immediate versus delayed nephrectomy for failed renal transplants.

The role of timing of transplant nephrectomy after renal transplantation has not been well defined. This report compares the morbidity, mortality, and hospitalization costs of 37 patients undergoing transplant nephrectomy within 14 days after graft failure and return to dialysis, with 31 patients undergoing delayed transplant nephrectomy (less than 14 days after graft failure and return to dialysis). This analysis revealed that there were no significant (P greater than .05) differences in patient morbidity and mortality between these groups. There was, however, a substantial increase (P less than .05) in the cost of hospitalization in the delayed nephrectomy group. For this reason, we recommend early nephrectomy after renal transplant failure in order to minimize the cost of health care for these patients undergoing failed cadaver donor transplant nephrectomy.

Costs and Cost Analysis↗

PubMed1987

Renal transplant nephrectomy.

There is surprisingly little about the problems of transplant nephrectomy reported in the literature, despite the frequency of the procedure and the recognition that it can be a difficult technical challenge. Of 480 kidneys transplanted during a ten year period, 154 (32 per cent) were later removed. One hundred and eleven (72 per cent) nephrectomies were performed because of uncontrollable acute rejection within three months of transplantation. Thirty-eight (25 per cent) nephrectomies were performed because of graft failure due to chronic rejection and five (3 per cent) were carried out for other reasons. The only significant problem that occurred during graft nephrectomy was difficulty in controlling bleeding which occurred at nine (6 per cent) operations. No patient died during the operation. In the postoperative period, there were two (1 per cent) complications, perforated peptic ulcer and pseudomembranous colitis, which led to death and 22 (14 per cent) which were successfully treated. These consisted of nine infections, five lymph leaks, four hematemeses, three secondary hemorrhages and one urine leak. No significant difference could be shown in morbidity and mortality with respect to the time lapse between transplantation and graft nephrectomy. Transplant nephrectomy need not be as hazardous a procedure as has often been recorded provided it is not performed by an inexperienced surgeon, although the decision as to when to abandon a graft is often a finely balanced one.

Graft Rejection↗

PubMed1985

[Compensatory changes in beta 2-microglobulin handling in the remnant tubules after contralateral nephrectomy. Observations of beta 2-microglobulin excretion into the urine].

Serum and urinary beta 2-microglobulin (S-, U-beta 2MG), and creatinine clearance (C-cr) were examined in 41 nephrectomy cases, and changes in glomerular and tubular handling of beta 2MG such as filtered beta 2MG (Fil-beta 2MG), reabsorption of beta 2MG (Reab-beta 2MG) and fractional excretion of beta 2MG (FE-beta 2MG) were studied. Serum creatinine (S-cr) and S-beta 2MG increased significantly after nephrectomy. C-cr decreased immediately after nephrectomy (80%), but recovered up to 87% in 2 to 4 days postoperatively. Fil-beta 2MG decreased immediately after nephrectomy, but increased up to more than the preoperative level in 2 to 4 days postoperatively. On the other hand, Reab-beta 2MG decreased significantly immediately after nephrectomy, and it took 5 to 8 days until recovery. Consequently, urinary excretion of beta 2MG (Ex-beta 2MG) and FE-beta 2MG increased significantly 0 to 4 days postoperatively. These increases in Ex-beta 2MG and FE-beta 2MG were much higher than those seen in diabetic nephropathy, cadmium nephropathy and Cis-diamminedichloroplatinum (II) (CDDP) intoxication, and were not due to drug intoxication such as general anesthesia or antibiotics, but due to glomerulo-tubular unbalance. Clinical data of renal tubular handling of beta 2-microglobulin in cases of interferon therapy or unilateral nephrectomy revealed many interesting aspects of glomerulo-tubular adaptations, and micropuncture study or isolated tubule perfusion study are awaited.

Adolescent↗

PubMed1985

Identification of factors responsible for wound infection following allograft nephrectomy.

The advisability of routine allograft nephrectomy following rejection has not been clearly resolved. Rejected transplants may be a source of sepsis, local inflammatory symptoms, and continued antigenic stimulation. Transplant nephrectomy is, however, attended by a surprisingly high incidence of septic complications and death. In an attempt to analyze the occurrence of these, and identify effective prophylactic maneuvers, the authors retrospectively studied 99 consecutive allograft nephrectomies in 252 consecutive renal transplants. Mortality following allograft nephrectomy was 10 per cent, and usually attributable to sepsis. Wound infections occurred in 24 per cent of these patients and were significantly associated with a preoperative site of infection in the wound, urinary tract, or blood (P less than 0.01). Preoperative antibiotics, wound irrigation, drains, and delay in performing allograft nephrectomy were all found to be insignificant variables. Interestingly, total steroid dose was less in patients who developed wound infections than in those who did not (P less than 0.01). A postoperative wound infection approximately doubled the mean number of hospital days. These data suggest that a significant reduction in morbidity and possibly mortality could be accomplished by complete eradication of infection prior to allograft nephrectomy. Consequent delay in removal of the graft is not associated with increased morbidity, and other maneuvers seem to have little beneficial effect.

Humans↗

PubMed1982

[Bilateral stage nephrectomy as a preparation for kidney transplantation].

The indication for nephrectomy prior to kidney transplantation has changed. Contrary to the formerly in nearly all transplantation centres practiced one-time two-sided nephrectomy, at present the removal of the patient's own kidneys prior to transplantation is done only if strictly indicated. In contrast to other transplantation centres which, if indicated, still today carry out bilateral nephrectomy prior to transplantation is done only if strictly indicated. In contrast to other transplantation centres which, if indicated, still today carry out bilateral nephrectomy prior to transplantation, since 1977 the transplantation centre of Munich prefers the two-time bilateral nephrectomy. Technique, surgical approach, indication and results of our method are presented. In the course of the discussion the disadvantages of the one-time bilateral nephrectomy are opposed to the advantages of the two-time method.

Candidiasis↗

PubMed1995

Risk factors affecting second renal transplant outcome, with special reference to primary allograft nephrectomy.

Removal of a failed primary renal allograft was found by some groups to adversely affect the outcome of a second kidney transplant. Recent data does not support this view and fail to show any such effect. Such data, however, are limited by small numbers or univariate analysis. The records of 192 patients receiving a primary and a subsequent kidney transplant between January 1980 and July 1992 were retrospectively reviewed. Immunosuppression initially included azathioprine and prednisone; cyclosporine was introduced in December 1983 with Minnesota antilymphocyte globulin (MALG) added for induction in May 1987. Regraft survival rates were 66% at one year and 60% at two years. Using Kaplan-Meier survival analysis patients having primary transplant nephrectomy had a worse second allograft outcome than patients who kept their failed grafts (P = 0.0003). Multivariate analysis showed a significant relationship between primary allograft survival and retransplant outcome. To eliminate this influence, patients whose first graft failed within six months of transplantation were excluded from the analysis. This resulted in 90 patients whose first graft functioned for more than 6 months. Graft survival was 80% at one year and 73% at 2 years in this select population. Patients with prior transplant nephrectomy still had a worse retransplant outcome than those who kept their failed grafts (P = 0.05). Multivariate analysis identified primary allograft nephrectomy, older donor age, longer interval from nephrectomy to retransplant, and lack of MALG at induction as negative risk factors. In conclusion, primary allograft nephrectomy may have a negative influence on second renal transplant outcome. This result may be improved by reducing donor age and the time interval from nephrectomy to retransplantation, and using MALG at induction.

Adult↗

PubMed1995

Comparison between standard flank versus laparoscopic nephrectomy for benign renal disease.

To evaluate the role of laparoscopic nephrectomy in the management of benign renal diseases, 12 patients undergoing laparoscopic nephrectomy were compared to 13 undergoing a classical flank nephrectomy. Both groups were similar in regard to patient age and indications for surgery. The underlying pathological conditions included vesicoureteral reflux, tuberculosis, hydronephrosis, hypertension and failed pyeloplasty. Overall, operative time ranged from 105 to 360 minutes (mean 145) for the laparoscopic group and 60 to 240 minutes (mean 156.6) for the open surgery group. Hospital stay and interval to return to regular preoperative activities were 2 to 6 days (mean 3.5) and 10 to 21 days (mean 16) for patients undergoing laparoscopic nephrectomy, which was significantly shorter than for those undergoing a flank procedure, 3 to 16 days (mean 8) and 35 to 84 days (mean 32.3), respectively. Pain medication requirements were also markedly decreased after laparoscopic nephrectomy. Of the patients in the laparoscopic group 2 experienced complications with only 1 requiring conversion to open nephrectomy. The laparoscopic technique is an effective as the flank approach for benign renal conditions, while providing a more rapid recuperation and superior cosmetic result.

Adult↗

PubMedDate not supplied

Transperitoneal laparoscopic nephrectomy in children: surgical technique with 3 trocars.

INTRODUCTION: The first videolaparoscopic nephrectomy in children was performed in 1992, and since then, little experience, and small series of pediatric patients have been reported. The technique, described by Clayman and accepted worldwide, requires the insertion of 4 or 5 trocars. Introduction of trocars is an important cause of complication in videolaparoscopic surgery. The authors report laparoscopic transperitoneal nephrectomy in children using only 3 trocars, to minimize risk of vascular injury or visceral perforation. SURGICAL TECHNIQUE: The patient is placed in supine position with flank rotated at approximately 45(degrees). After pneumoperitoneum is established, the first trocar is introduced in umbilicus for the laparoscope. Under direct vision, the second trocar is placed at ipsilateral midclavicular line, and the third and last trocar in the epigastric region. Laparoscopic transperitoneal nephrectomy was performed in 3 children aged 7, 8, and 14 years old. Right nephrectomy was performed in 2 cases, and left nephrectomy in one. Mean operative time was 163 min (100 to 230 min), and no transfusion was necessary. Patients were discharged from hospital on day 2 to 4 after the procedure. There were no conversions to open surgery, and no intra or postoperative complications. COMMENTS: Every trocar and instrument introduction into the abdominal cavity presents an important risk of vascular injury or visceral perforation. The risk per patient is naturally increased with the number of trocars utilized. Injuries during laparoscopic procedures can theoretically damage every intra- or retroperitoneal organ. The majority of these lesions will need immediate or delayed open surgery, due to hematoma formation, postoperative bleeding, abscess, or peritonitis. Transperitoneal videolaparoscopic nephrectomy in children can be performed using only 3 trocars. The technique allows a better cosmetic result, and reduces the risk of trocar introduction injuries, like vascular and visceral lesions.

Journal Article↗

PubMed2003

Laparoscopic total and partial nephrectomy-the new standard?

Laparoscopic radical nephrectomy has been shown in long-term follow-up to provide shorter patient hospitalization and effective cancer control with no significant difference in survival compared with open radical nephrectomy. The major technical issue for success of laparoscopic partial nephrectomy is hemostatic control, and several techniques have been developed to improve control. Laparoscopic partial nephrectomy continues to evolve along two therapeutic technical avenues: hilar clamping with ischemia versus no hilar clamping. The benefits of laparoscopy for the kidney have clearly been demonstrated in terms of less pain, decreased convalescence, and decreased narcotic requirements. With short-term outcomes demonstrating laparoscopic partial nephrectomy as an efficacious procedure, the role of laparoscopic partial nephrectomy should continue to increase.

Journal Article↗

PubMed2026

Perioperative safety and survival outcomes of robot-assisted partial nephrectomy in elderly patients with localized renal cell carcinoma: an overlap-weighted Asian cohort study.

The value of robot-assisted partial nephrectomy (RAPN) in elderly Asian patients with localized renal cell carcinoma (RCC) remains insufficiently defined. We retrospectively analyzed 339 patients (≥ 70 years) with localized RCC treated at a single Asian center between 2015 and 2025, including 119 undergoing partial nephrectomy (PN) and 220 undergoing radical nephrectomy (RN). Propensity score overlap weighting (OW) was applied to compare PN versus RN and, within the PN cohort, RAPN versus laparoscopic partial nephrectomy (LPN). Three open partial nephrectomy cases were summarized descriptively and retained only in exploratory sensitivity analyses. Weighted logistic regression and Cox models with robust standard errors evaluated Clavien-Dindo grade ≥ II complications and overall survival (OS). After OW, PN was associated with better early postoperative renal functional preservation than RN but a greater incidence of grade ≥ II complications (36.4% vs. 17.6%; weighted p < 0.001); OS was similar. Within the PN cohort, RAPN had longer operative time than LPN (weighted p = 0.030), whereas warm ischemia time, early postoperative eGFR, and grade ≥ II complications (31.8% vs. 40.4%; weighted p = 0.414) were not significantly different. Exploratory analyses favored RAPN, but only one death occurred in this group, and residual confounding remains possible. PN may preserve early renal function in selected older patients, while RAPN appears feasible in experienced centers; its survival association remains hypothesis-generating.

Humans↗

PubMed2005

More than 500 consecutive laparoscopic donor nephrectomies without conversion or repeated surgery.

HYPOTHESIS: Concern exists as to the safety of laparoscopic donor nephrectomy (LDN) compared with open donor nephrectomy. Reported complications of LDN include emergent conversion to an open procedure, repeated surgery for postoperative bleeding, and even death. We hypothesize that LDNs can be performed safely, with a complication rate comparable with that of open donor nephrectomies. DESIGN: Case series and review of the literature. SETTING: Tertiary care university hospital. PATIENTS: Five hundred thirty kidney donors. INTERVENTION: An LDN performed without hand assistance, with the kidney extracted through a low transverse incision. MAIN OUTCOME MEASURES: Mean operative time, requirement for transfusion, intraoperative complications, and postoperative complications. RESULTS: This series includes 84 right-sided donor nephrectomies, 86 donors with a body mass index greater than 30 (calculated as weight in kilograms divided by the square of height in meters), and 91 donors with complex vascular anatomy. Mean donor age was 40 years (range, 18-73 years), and mean +/- SD operative time was 196 +/- 43 minutes. The only conversion occurred early in the series, and there have been 525 subsequent cases without the need for conversion or repeated surgery. There were no donor deaths. Five donors (0.9%) required perioperative blood transfusions. Overall complication rate was 6.4%, including 14 minor wound infections, 2 bowel injuries, 1 case of prolonged ileus, 3 splenic injuries, 2 bladder infections, 1 bladder injury, 1 case of rhabdomyolysis, 1 case of pneumonia, and 2 thromboembolic events. CONCLUSION: This series demonstrates that LDN can be performed at least as safely as open donor nephrectomy, with minimal bleeding and few postoperative complications.

Adolescent↗

PubMed1994

Partial nephrectomy for renal cell carcinoma with a normal opposite kidney.

BACKGROUND: The role of nephron-sparing surgery in patients with unilateral renal carcinoma and a normal opposite kidney is controversial. METHODS: The number and selection criteria of patients undergoing a partial nephrectomy versus radical nephrectomy from 1979 to 1991 were compared. RESULTS: Of 230 patients having curative surgery for unilateral renal cell carcinoma, 41 had a partial nephrectomy. The percentage of partial compared with total nephrectomies performed increased from 8% in 1979-84, to 20% in 1984-88, and 30% in 1989-91. The increased number of partial versus radical nephrectomies performed reflected an increased detection of small (3.5 cm) incidental renal tumors by radiologic imaging. The local recurrence rate was 2.4% (one patient), and the survival rate was 95% (average, 3 years). CONCLUSION: Complete local excision of the small serendipitous renal tumor is feasible and reasonable in the patient with an otherwise normal opposite kidney.

Adult↗

PubMed2001

Laparoscopic radical nephrectomy in 100 patients: a single center experience from the United States.

BACKGROUND: The objective of the current study was to report a single-surgeon, single-center experience with 100 consecutive laparoscopic radical nephrectomies with intact specimen extraction, with the aim of evaluating the oncologic adequacy of the laparoscopic dissection from a technical standpoint and various parameters including the learning curve. METHODS: Of the 140 laparoscopic radical nephrectomies performed at the study institution since August 1997, the initial 100 are evaluated herein. To evaluate the technical oncologic adequacy, comparison was made with 40 contemporary open radical nephrectomy specimens with regard to detailed radiologic (computed tomography scan) and pathologic data. RESULTS: In the 100 patients studied (with a mean tumor size of 5.1 cm), the mean surgical time was 2.8 hours, the blood loss was 212 mL, the specimen weight was 554.3 g, and the hospital stay was 1.6 days. Complications occurred in 14 patients (14%) and were major in 3 (3%) and minor in 11 (11%). Two patients (2%) were converted to open surgery. There was no perioperative mortality. Over a mean follow-up of 16.1 months, there was no local or port site recurrence reported; 2 patients developed metastatic disease with 1 death occurring at 11 months. When evaluating the learning curve in the initial 50 versus the second 50 patients, a shorter surgical time (P = 0.02) appeared to be the only significant variable. On multivariate analyses, the only variables found to impact on surgical time were specimen weight (P < 0.001) and chronologic time period of surgery (P = 0.05). All laparoscopic specimens were extracted intact; surgical margins were negative for tumor in all 100 patients. All detailed radiologic and histopathologic parameters evaluated were nearly identical between the laparoscopic and open surgery groups. CONCLUSIONS: Laparoscopic radical nephrectomy with intact specimen extraction currently is a routine, effective, and efficacious treatment option for patients with T1-T3aN0M0 renal tumors. Although no long-term data were available as of last follow-up, the negative surgical margins achieved routinely in the current series provide encouraging surrogate evidence of the technical efficacy of laparoscopy from an oncologic standpoint. As such, at the study institution, laparoscopic radical nephrectomy with intact specimen extraction currently is the standard-of-care for patients with T1-3aN0M0 renal tumors measuring < or = 10-12 cm in size.

Adult↗

PubMed1994

Nephrectomy for metastatic renal cell carcinoma: a component of systemic treatment regimens.

New immunotherapeutic and chemotherapeutic regimens have altered the medical approach to metastatic renal cell carcinoma (RCC). Surgery for metastatic RCC needs to be reappraised in the context of these developments. We retrospectively examined the course of 25 patients with metastatic RCC who underwent nephrectomy or resection of renal fossa recurrences as an adjunct to intended systemic therapy. Four patients (16%) had complications and there was no perioperative mortality. Of 23 patients who had surgery first, 17 received subsequent systemic therapy and 2 experienced a response. Two patients underwent nephrectomy after achieving a partial response with systemic therapy. Overall, 3 patients (12%) are alive without detectable disease, 8 (32%) are alive with disease, and 14 (56%) are dead of disease, with a median survival of 23.5 months. Nephrectomy for metastatic renal cell carcinoma may be associated with less morbidity and mortality than previously reported. When initial nephrectomy is performed, most patients go on to receive systemic therapy. Within the context of a systemic treatment regimen, nephrectomy continues to play a role in the management of selected patients with metastatic RCC.

Carcinoma, Renal Cell↗

PubMedDate not supplied

Metabolic and renal effects of Laevo-carnitine and propionyl-carnitine in rats with subtotal nephrectomy.

The renal and metabolic effects of chronic carnitine administration were evaluated in the early stages of experimentally-induced renal failure. Laevo-carnitine (n = 5), Propionyl-carnitine (n = 5) both at 200 mg kg-1 of body weight, or vehicle (physiological saline solution, 0.4 ml kg-1 body weight, n = 5) were administered daily for 3 days prior to 2/3 nephrectomy and for 25 days thereafter, by intraperitoneal route. At the end of the experiment, no significant differences were found in systolic blood pressure and heart rate among groups. During the 25 days after nephrectomy, body weight increased by 71 +/- 13 g in the control group and by 50 +/- 26 g and 42 +/- 9 g in Laevo-carnitine and Propionyl-carnitine groups, respectively (P < 0.05 vs control for both comparisons). Urinary sodium excretion was increased in carnitine-treated rats (Laevo-carnitine: from 1.03 +/- 0.3 to 1.36 +/- 0.3 mEq day-1, Propionyl-carnitine: from 1.2 +/- 0.2 to 1.66 +/- 0.2 mEq day-1, P < 0.05 for both comparisons), but not in those given vehicle. Twenty-five days after nephrectomy, plasma creatinine was lower in carnitine-treated rats (Laevo-carnitine: 0.98 +/- 0.12 mg dl-1, Propionyl-carnitine: 1.06 +/- 0.15, vehicle: 1.52 +/- 0.09, P < 0.05 vs control for both comparisons). Plasma triglycerides and VLDL were decreased by nephrectomy and this effect was prevented by carnitine treatment. The data indicate that the carnitine blunts the increase in plasma creatinine that occurs early after partial nephrectomy and normalizes the plasma lipoprotein pattern. Thus, carnitine might protect against the development of renal failure in this experimental model.

Animals↗

PubMed1995

Glomerular hypertrophy after subtotal nephrectomy: relationship to early glomerular injury.

Structural adaptations in response to approx. 70% nephrectomy were studied in male Sprague-Dawley rats. Rats developed systemic hypertension as well as progressive albuminuria after nephrectomy. At 18-26 weeks after nephrectomy (n = 6) or sham treatment (n = 6) kidneys were perfusion-fixed and examined by light and electron microscopy. Glomerular tuft volume (+140%), capillary volume (+151%) and length (+77%), mesangial volume (+115%), podocyte volume (+96%), glomerular basement membrane surface area (+107%) and filtration slit length (+85%) were all significantly greater in nephrectomized rats. The incidence of segmental glomerular sclerosis was low and variable among these rats, but was significantly higher than in controls (P = 0.037). Urinary albumin excretion was elevated in the nephrectomized rats (89 +/- 72 SD mg/day vs 11 +/- 11 mg/day in control rats, P = 0.01) and correlated significantly with the incidence of sclerosis (r = +0.8311, P < 0.05). The relationships of the level of albuminuria and the sclerosis rate to various morphometric parameters were examined by regression analysis for the nephrectomy group. A significant negative correlation was found between albuminuria and average tuft volume (r = -0.8136) and glomerular basement membrane surface area (r = -0.8168). Both sclerosis rate and albuminuria showed negative correlations with filtration slit length (r = -0.8180 and r = -0.8598). These findings suggest that under some circumstances, glomerular hypertrophy may prevent or ameliorate the early stages of glomerular injury after subtotal nephrectomy.

Animals↗

PubMed1976

The influence of nephrectomy, ureteral ligation, and of estradiol on plasma renin substrate in unilaterally nephrectomized rats.

The effects of three experimental conditions on the concentration of plasma renin substrate were studied with special reference to plasma renin concentration in unilaterally nephrectomized rats. After simultaneous bilateral nephrectomy the maximum increase in plasma renin substrate was 17 times higher than normal within 24 h, while in rats which were unilaterally nephrectomized 10 days previously, followed by the removal of the remaining kidney (two-step bilateral nephrectomy), the maximum increase in plasma renin substrate was markedly suppressed (6-fold of normal). The maximum increases in plasma renin substrate by estradiol treatment in normal and unilaterally nephrectomized rats were about the same, associated with similarly decreased plasma renin concentrations. The similar increase in plasma renin substrate was found after ureteral ligation in unilaterally nephrectomized rats and bilateral ligation of the ureters in normal rats. This was the case where the plasma renin concentrations changed differently after ureteral ligation. After two-step bilateral nephrectomy plus estradiol treatment the maximum increase in plasma renin substrate was found to be higher than that found after two-step bilateral nephrectomy, but was lower than that after simultaneous bilateral nephrectomy. It is suggested that under the pathological conditions that stimulate renin substrate production, the plasma rein substrate concentration is less affected by circulating renin.

Angiotensin II↗