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At least 955 records · Page 53Linked to original sources
PubMed1986

The adrenal gland and renal cell carcinoma: is ipsilateral adrenalectomy a necessary component of radical nephrectomy?

The ipsilateral adrenal gland may be involved by renal cell carcinoma through direct invasion or embolic metastases, and usually it is removed as part of the radical nephrectomy specimen. We reviewed retrospectively 44 patients with stage A and 8 patients with stage B renal cell carcinoma, 25 of whom had undergone ipsilateral adrenalectomy. The 5-year and 9-year survival of these 25 patients was 79 and 65 per cent, respectively, and was not statistically different from the 78 per cent 5-year and 9-year survival of those 27 patients who did not undergo ipsilateral adrenalectomy. These findings suggest that the ipsilateral adrenal gland need not be removed routinely as part of perifascial nephrectomy for renal cell carcinoma. Those patients who are found to have a contralateral adrenal lesion during preoperative evaluation should be spared bilateral adrenalectomy if there is no ipsilateral adrenal gland involvement at exploration. Those patients with lower pole lesions also need not undergo routine ipsilateral adrenalectomy. Preoperative computerized tomography scans will help to select those tumors that can be managed by perifascial nephrectomy with sparing of the ipsilateral adrenal gland.

Adrenal Gland Neoplasms↗
PubMed1985

Combination of CUSA and neodymium:YAG laser for canine partial nephrectomy.

A Cavitron Ultrasonic Surgical Aspirator (CUSA) was used to isolate and skeletonize parenchymal renal vessels during 20 partial nephrectomies performed on 10 dogs. After isolation of the renal vessels, hemostasis was obtained by direct application of neodymium:YAG laser energy. Blood loss and total operative time were reduced compared to a control series of partial nephrectomies performed with a scalpel. The combination of Cavitron Ultrasonic Surgical Aspirator plus a Nd:YAG laser appears to offer advantages compared to either modality used alone or to standard techniques for partial nephrectomy.

Animals↗
PubMed1985

Selective pre-transplant nephrectomy: indications and perioperative management.

From May 1977 to June 1983, 198 patients were accepted as candidates for renal transplantation at our university. We review our experience with 14 consecutive patients who underwent selective pre-transplant nephrectomy during this interval. Indications for this procedure included recurrent or chronic pyelonephritis, structural abnormalities of the urinary tract predisposing the patient to infection, malignant or renin-dependent hypertension, Goodpasture's disease, certain cases of rapidly progressive glomerulonephritis and selected patients with polycystic kidneys. All patients underwent dialysis 1 day preoperatively. Perioperative fluid losses were measured carefully with prompt and vigorous replacement therapy. Patients received an average of 5,890 cc fluid replacement before postoperative dialysis. All patients underwent dialysis within 29 hours postoperatively. There were no postoperative deaths and 8 complications. Selective pre-transplant nephrectomy has spared 93 per cent of potential renal transplant candidates from a major surgical procedure. No patient has required removal of the original kidneys during the post-transplant period. Our experience has shown that the reluctance to hydrate these patients is unwarranted and that prompt postoperative dialysis, if required, is safe. Since some end stage kidneys are physiologically active and the associated surgical risk is high, pre-transplant nephrectomy should be performed only in carefully selected patients. In contrast to previous reports, which advocated minimal fluid administration and delayed postoperative dialysis, our recent experience indicates that vigorous fluid replacement therapy, carefully monitored with serial vital signs, weights, serum electrolytes and central venous pressure readings, will avert many of the complications encountered previously.

Adolescent↗
PubMed1984

Effect of unilateral nephrectomy on growth of the Wistar/Furth Wilms' tumor.

Compensatory renal growth, that is, renal growth following contralateral nephrectomy, is mediated by either the elaboration or the activation of a renotrophic growth factor. Since tumor growth may be modulated by various factors, we evaluated the effect of the renotrophic growth factor associated with compensatory renal growth on the Wistar/Furth rat Wilms' tumor. When compared to tumors grown in sham nephrectomized animals, tumors grown in animals who had undergone unilateral nephrectomy showed an increase in tumor weight and in DNA content. In addition, the rate of new cell formation as reflected by the uptake of tritiated thymidine into tumor cells was significantly higher and did not decline when tumors grown in animals who had undergone unilateral nephrectomy were compared to tumors from sham nephrectomized animals. Our studies therefore suggest that the renotrophic growth factor associated with compensatory renal growth may have ubiquitous growth regulating activity and that further studies may elucidate its role in the modulation of normal and neoplastic growth.

Animals↗
PubMed1983

Angioinfarction plus nephrectomy for metastatic renal cell carcinoma--an update.

We treated 100 patients with metastatic renal cell carcinoma by angioinfarction of the primary tumor followed by radical nephrectomy. Of the patients 88 also received postoperative parenteral progesterones. We achieved an over-all response rate of 28 per cent (complete regression of all metastatic lesions in 7 patients, regression greater than 50 per cent in 8 and stabilization for at least 1 year in 13). Patients with parenchymal pulmonary metastases only have the best survival rate (64 per cent at 1 year) and are most likely to benefit from angioinfarction and nephrectomy. The presence of hilar or mediastinal adenopathy, pleural effusion or nonpulmonary metastases confers a worse prognosis. These patients do not appear to survive longer with preoperative angioinfarction than if treated by nephrectomy alone. Our data demonstrate that it is critically important to stratify patients by site and volume of disease when results are reported and compared for any patient undergoing treatment for metastatic renal cell carcinoma.

Adenocarcinoma↗
PubMed1981

Pediatric nephrectomy.

A retrospective revue of 90 consecutive nephrectomies revealed 25 instances in which the nephrectomy was done for poor or diminished function only (28 per cent). The pathology was ureteropelvic obstruction (18 cases), reflux (4 cases) and obstructive megaureter (3 cases). All conditions are reparable. Although some kidneys in children are worthless and best removed, most have significant potential function if the anatomical defect is repaired. Poor or diminished renal function in children should not be an absolute indication for nephrectomy.

Child↗
PubMed1980

Transperitoneal live donor nephrectomy.

We review 171 anterior transperitoneal live donor nephrectomies. The transperitoneal approach provides optimum exposure for atraumatic dissection of the kidney and renal vessels. The total and major postoperative complication rates were 30.4 and 3.5 per cent, respectively. These results compare favorably to reported series of extraperitoneal live donor nephrectomies. Transperitoneal live donor nephrectomy is a safe and effective operation with low risk to the donor.

Nephrectomy↗
PubMed1979

A review of 117 partial nephrectomies.

In this review of 117 consecutive partial nephrectomies calculi associated with infection was the most common indication for the operation. Other indications included congenital anomalies, trauma, arteriovenous malformations and tumor. Partial nephrectomy has been shown to be a relatively safe procedure, with a mortality rate of 1.7 per cent. However, considerable morbidity occurred when stone and/or infection persisted postoperatively. We herein emphasize that total intraoperative removal of calcareous debris, appropriate treatment of associated infection and avoidance of nephrostomy tubes are important to a successful postoperative result. Partial nephrectomy as a method to remove stones confined to or originating in a diseases calix appears unsurpassed.

Adolescent↗
PubMed1977

Partial nephrectomy in the treatment of renal adenocarcinoma.

During a 20-year period 17 patients underwent partial nephrectomy as primary curative therapy for renal adenocarcinoma. In 15 patients (88 per cent) partial nephrectomy was performed satisfactorily in situ with free margins of resection. Eleven patients are alive (65 per cent) and only 3 (17 per cent) died of recurrent malignant disease. There was no operative mortality and postoperative complications were minimal. A review of the literature reveals that partial nephrectomy is an effective form of therapy for patients with bilateral renal carcinoma or carcinoma occurring in a solitary kidney.

Adenocarcinoma↗
PubMed1975

Is nephrectomy justified in patients with metastatic renal carcinoma?

The survival data of 93 patients with metastatic renal carcinoma are discussed with respect to the site of metastasis and whether nephrectomy was performed as part of the initial treatment. Analysis of the cumulative survival rates revealed that nephrectomy significantly increased survival only for those patients pesenting exclusively with osseous metastases. Nephrectomy did not alter survival for patients with pulmonary and/or soft tissue metastases.

Adult↗
PubMed1985

Treatment of renal cell carcinoma by in situ partial nephrectomy and extracorporeal operation with autotransplantation.

During a 10-year period, 33 patients underwent in situ enucleation, in situ partial nephrectomy, or an extracorporeal operation for low-grade (1 or 2), low-stage (I or II), bilateral or solitary renal cell carcinoma. Only one patient (3%) (who had undergone in situ partial nephrectomy) had local recurrence; the projected 5-year rates of nonprogression of disease and survival from death due to cancer only were 76% and 87%, respectively. A group of patients who were closely matched for grade and stage of renal cell cancer underwent traditional transabdominal radical nephrectomy during the same time interval and had rates of nonprogression and survival similar to those of the conservative surgical group. Thus, in selected patients with low-grade, low-stage renal cell cancer, conservative surgical treatment (that is, renal parenchyma-saving procedures) can produce favorable results without the side effects (such as renal failure) associated with ablative renal operations.

Adult↗
PubMed2000

Hand-assisted laparoscopic bilateral nephrectomy.

Open bilateral nephrectomy in renal transplant patients may be indicated for various reasons and is associated with a significant rate of morbidity and mortality. Laparoscopic bilateral nephrectomy may favorably influence postoperative recovery but is technically difficult. This case report is the first description of hand-assisted laparoscopic bilateral nephrectomy. We believe this technique significantly shortens the operative time, increases the safety of the procedure, and assures the patient the benefits of minimal invasive surgery in terms of postoperative pain and recovery.

Female↗
PubMed2001

Renal artery pseudoaneurysm occurring after partial nephrectomy.

Retroperitoneal hemorrhage resulting from intrarenal pseudoaneurysm formation has been reported after percutaneous renal surgery. However, although hemorrhage is a well-recognized complication of partial nephrectomy, hemorrhage caused by an intrarenal pseudoaneurysm after open partial nephrectomy is rare. We report a case of retroperitoneal hematoma associated with a renal artery pseudoaneurysm occurring in a 56-year-old woman 2.5 weeks after she underwent left partial nephrectomy for renal cell carcinoma. The pseudoaneurysmal branch was successfully identified and selectively embolized using percutaneous renal arterial angiography.

Abdominal Pain↗
PubMed2002

Posterior approach for retroperitoneal laparoscopic bilateral nephrectomy in a child.

We report on a unique posterior approach for bilateral nephrectomy by retroperitoneoscopy that was conducted in a 13-year-old boy with end-stage renal disease managed by peritoneal dialysis. A posterior approach for bilateral nephrectomy by retroperitoneal laparoscopy provided adequate visualization and created enough working space for the manipulation. The procedure was performed during a short period, and the patient did not need to be repositioned. Retroperitoneal laparoscopic bilateral nephrectomy is a useful option in school-aged children with poorly functioning kidneys, particularly those children also undergoing peritoneal dialysis.

Adolescent↗
PubMed2002

Prognostic features of pathologic stage T1 renal cell carcinoma after radical nephrectomy.

OBJECTIVES: To assess the effect of renal cell carcinoma (RCC) subtype, tumor size, and Fuhrman grade on clinical outcome in patients with pathologic T1 (pT1) RCC treated with radical nephrectomy. METHODS: Between 1970 and 1998, 840 patients underwent radical nephrectomy for pT1 RCC. Tumors were subtyped and graded. Univariate and multivariate Cox proportional hazards models were fitted to assess the features associated with metastasis-free survival (MFS) and cancer-specific survival (CSS). We identified a range of tumor sizes of clear cell RCC in which a transition occurred from low to high risk. Cox proportional hazards models were then fitted by using size cutoffs. RESULTS: The mean follow-up (+/- SD) was 9.4 +/- 6.6 years among the patients alive at latest follow-up. At 10 years, the CSS and MFS for clear cell RCC (n = 682) were 89.1% and 88.6%, respectively; for papillary RCC (n = 122), they were 95.5% and 93.8%; and for chromophobe RCC (n = 33), they were both 100%. The differences in CSS (P = 0.013) and MFS (P = 0.023) between clear cell RCC and the other subtypes were statistically significant. For clear cell RCC, tumor size and Fuhrman grade were independently associated with CSS and MFS (P <0.001). A transition in risk occurred for tumor sizes between 4.5 and 5.0 cm, and the tumor size cutoff of 5.0 cm had the highest concordance index for predicting CSS and MFS. CONCLUSIONS: RCC subtype is a strong independent prognostic variable for patients with pT1 RCC treated with radical nephrectomy. For clear cell RCC, Fuhrman grade and tumor size are independently associated with CSS and MFS.

Adenocarcinoma, Clear Cell↗
PubMed2002

Natural history of chronic renal insufficiency after partial and radical nephrectomy.

OBJECTIVES: To compare the incidence of newly developed chronic renal insufficiency after partial nephrectomy (PN) and radical nephrectomy (RN). Elective PN for renal tumors is intended to preserve renal function; however, studies of transplant donors suggest normal renal function is also maintained after unilateral nephrectomy. METHODS: We retrospectively compared all patients undergoing PN or RN for renal tumors 4 cm or less in the presence of a normal contralateral kidney from 1989 to 2000. Creatinine failure was defined as a serum creatinine value greater than 2.0 mg/dL. Risk factors for renal insufficiency, including diabetes, hypertension, American Society of Anesthesiologists score, age, preoperative creatinine, and history of smoking tobacco, were compared between the two groups. We compared the two groups using the chi-square and Mann-Whitney U tests and the creatinine failure rates using the Kaplan-Meier method. RESULTS: One hundred seventy-three patients met the criteria for analysis after RN and 117 did so after PN (median follow-up 25 months). The 5-year freedom from recurrence rate was 96.4% and 98.6% for PN and RN, respectively (P >0.05). The mean preoperative serum creatinine was 1.0 mg/dL (range 0.4 to 1.4) and 0.98 (range 0.6 to 1.5) for RN and PN, respectively (P = 0.4, not significant). The incidence of risk factors for renal insufficiency did not differ between the two groups. The mean postoperative serum creatinine in the RN and PN groups was 1.5 mg/dL (range 0.8 to 3.8) and 1.0 mg/dL (range 0.5 to 1.9), respectively (P <0.001). The chance of creatinine failure over time was significantly greater in the RN group (P = 0.008). CONCLUSIONS: When controlled for preoperative risk factors for renal insufficiency, patients undergoing RN are at a greater risk of chronic renal insufficiency than a similar cohort of patients undergoing PN.

Adult↗
PubMed2002

Effect of ketorolac on renal function after donor nephrectomy.

OBJECTIVES: To evaluate the safety of ketorolac, a nonsteroidal anti-inflammatory drug, that is being used more frequently for postoperative analgesia, we performed a detailed analysis of healthy patients undergoing open donor nephrectomy. METHODS: We conducted a retrospective review of 198 consecutive patients who underwent open living donor nephrectomy between January 1998 and July 2000. We compared patients who were and were not given ketorolac. Regression analysis was used to determine whether any significant interactions were present between ketorolac and donor age, sex, weight, estimated surgical blood loss, or operative time in terms of its effect on renal function. Creatinine clearance was calculated by the Gault-Cockcroft equation. RESULTS: Among the 83 patients given ketorolac, the mean amount received was 200 mg (range 30 to 360, median 210). No differences were found in the preoperative creatinine clearance between patients who did (118 +/- 29 mL/min) or did not (118 +/- 27 mL/min, P = 0.89) receive ketorolac. Patients who received ketorolac had a slightly lower creatinine clearance on the second postoperative day relative to patients who did not receive ketorolac (66% versus 72% of preoperative calculated creatinine clearance, P = 0.05). However, at a minimum of 3 months postoperatively, the creatinine clearance did not differ between the two groups (70% versus 73%, P = 0.92). Among patients who received ketorolac, no significant association was found between the amount received and renal function at any point tested. In the regression analysis, no significant interactions were found between ketorolac and the clinical variables of age, sex, weight, estimated surgical blood loss, or operative time. Moreover, in an analysis of only the patients who received ketorolac, no significant interactions were found between the amount of ketorolac received and the clinical variables of age, sex, weight, estimated surgical blood loss, or operative time. CONCLUSIONS: Ketorolac use was not associated with any long-term impairment in renal function when used during the first 2 postoperative days in healthy patients undergoing open donor nephrectomy. Moreover, in the range administered, no subset of patients or maximal ketorolac dose was identified at which ketorolac use was not safe.

Adult↗