COMPLICATIONS OF TRANSPERITONEAL RADICAL NEPHRECTOMY, A SINGLE CENTRE EXPERIENCE

Objective: To share our experience regarding complications of transperitoneal radical nephrectomy. Material and Methods: After approval from ethical committee a retrospective study was conducted extending from January 2012 to January 2014 to identify clinical characteristics of renal cell carcinomas, stag-ing of RCC, per operative and early post operative complications of transperitoneal radical nephrectomy. The study included all renal cancer patients presented to Sheikh Zayed Hospital Lahore with in this specified period. Detailed history and physical examination was performed. Haematological and radiological investigations including abdominopelvic ultrasonography, CT scan abdomen and pelvis were performed to stage the renal tumour. High resolution CT chest was per-formed where indicated. Radical nephrectomy performed through transabdominal approach and outcomes measured in terms of pre and post operative complicat-ions. Results: There were total of 50 cases. The male to female ratio was 3:2. Mean age of patients was 52.38 (18 – 93) years. Most common clinical presentation was gross haematuria(66%).The mean tumour size was 8.34 (3 – 24) cm. Operative findings in 40 patients (80%) were tumor limited to Gerota’s fascia and in 6 (12%) there was tumour involvement of renal vein or IVC. In 2 patients (4%) Lymphadenectomy was per-formed. Total operative time ranged between 120 to 180 minutes. Intra-operative splenic injury was seen in 2 (4%), while aortic injury was observed in one (2%) patient. Post operatively one (2%) developed pulmonary embolism, 2 (4%) chest infection while 2(4%) developed wound infection and 3 patients (6%) required blood transfusion. Tumour histology was clear cell in (84%), papillary transitional cell carcinoma (12%) and oncocytoma contributed 4%. Conclusion: Transperitoneal approach for radical nephrectomy is safe with minimal peroperative and early post-operative complications. It is also safe where tumour thrombus extends into IVC, as it provides good exposure of vessels.