Large tumor laparoscopically
For tumors larger than 7 cm, the main difficulties are limited space, abundant blood supply to the tumor with large collaterals, and displacement of the vascular pedicle. The surgeon isolates the kidney in Gerota's fascia with a wide coverage of the tissue, removes the adrenal gland and regional lymph nodes if necessary, a large specimen is removed through an additional incision of 6–8 cm. The probability of switching to open surgery is 5–10%, about which the patient is warned. If a blood clot is in the renal vein or vena cava or has grown into the liver, intestine or muscle, an open nephrectomy is performed.
Indications for radical nephrectomy
- renal cell carcinoma, in which resection is impossible: central location, large size (more than 7 cm), invasion into the pelvis or vessels;
- tumor with thrombus in the renal or inferior vena cava;
- metastatic kidney cancer - cytoreductive nephrectomy before systemic therapy;
- Wilms tumor and other malignant kidney tumors.
For tumors up to 4 cm (and often up to 7 cm), organ-sparing partial nephrectomy is preferred and is described on a separate page.
Laparoscopy and complexity categories
Laparoscopic radical nephrectomy is the standard for tumors without massive invasion and blood clots: 4–5 punctures, minimal blood loss, hospital stay 4–5 days. In the price list of clinics, the operation is divided according to the size of the tumor (up to 4 cm, 4–7 cm, more than 7 cm) - with the growth of the tumor, the duration, complexity of identifying vessels and the risk of conversion increase. Open nephrectomy is performed for giant tumors, blood clots in the vena cava, and growth into neighboring organs.
After surgery
Histology determines the type of cancer, grade and stage - these determine the choice of observation or adjuvant therapy (immunotherapy for high-risk patients). The remaining kidney provides full function; Control of blood pressure and creatinine and avoidance of nephrotoxic drugs are important. MSCT of the chest and abdomen is performed every 6 months for the first 2–3 years, then annually.
