To present the main anatomic landmarks and tips for a safe open left radical nephrectomy performed for a huge renal mass
Abstract
Objective
To present the main anatomic landmarks and tips for a safe open left radical nephrectomy performed for a huge renal mass.
Clinical Case
A 45 yrs old male reached our attention for recurrent episodes of left renal colic and gross haematuria. No relevant comorbidities were reported. At the physical exam a palpable renal mass was identified extending from the left hypochondrium to the omolateral iliac fossa and medially to the xifopubic line. Left varicocele was also encountered. The CT scan revealed a large left renal mass with multiple suspicious paraortic lymph nodes till the origin of the celiac trunk. The patient was submitted to open left radical nephrectomy and lymph node dissection. With the patient in the supine position a midline incision was made and the peritoneal cavity was entered. The descending colon was medialized. Multiple collateral peritumoral veins and a severely dilated genital vein were encountered. Reflection of the spleen and the pancreas was performed to expose the sub-diaphragmatic space [1]. Following the dissection of the ureter, the elements of the left renal hilum were isolated and controlled. Attention was paid to the splenic vessels, the tail of the pancreas and the superior mesenteric artery. The sidewall of the aorta and common iliac were kept in mind to maintain a frame of reference. The paraortic and truncal lymph nodes were also removed [2].
Results
Operating time was 6 hours. The pathology revealed a clear cell carcinoma infiltrating the perirenal fat and the left renal vein. Fourteen benign lymph nodes were identified. At one year of follow-up, the patient is free from local or distant recurrences.
Conclusions
Open surgery still represents an important therapeutic option for cases of renal cancer not amenable to mininvasive approach and should remain part of the armamentarium of the modern urologist [3].