Comparison of the Morbidity between Intrapleural and Extrapleural Approach in Thoracoabdominal Incision for Radical Nephrectomy in Patients with Renal Cell Carcinoma

Abstract

Purpose: A thoracoabdominal incision using the intrapleural approach provides optimal exposure for radical nephrectomy, especially in large tumors or tumors in the upper pole of the kidney. Intuitively it is perceived that the morbidity of this type of incision is greater. In this study, the morbidity between the intrapleural and extrapleural approach in a thoracoabdominal incision for radical nephrectomy in renal cell carcinoma were compared. Materials and Methods: Among the 62 patients undergoing thoracoabdominal radical nephrectomy for renal cell carcinoma, 20 patients underwent nephrectomy by the intrapleural approach (group I) due to an upper pole lesion (group IA, n=10) or a large tumor (group IB, n=10). Forty-two patients underwent nephrectomy by the extrapleural approach (group II). The operation time, the quantity of blood transfused during surgery, the postoperative hospital stay, the severity of pain and postoperative complications were assessed in order to compare the morbidity among the groups. Results: With regard to the mean operation time, there were only statistically significant differences between group IB and II (p=0.005). There were no statistically significant differences in terms of the intraoperative transfusion amount, postoperative hospital stay, pain severity, and complications between group I and II. Conclusions: The intrapleural thoracoabdominal approach was comparable to the extrapleural approach in terms of the operation time except for large tumors, intraoperative transfusion amount, postoperative length of hospital stay, pain severity, and complications. Therefore, for radical nephrectomy, an intrapleural thoracoabdominal incision could be used without increasing the risk of morbidity in large tumors or tumors in the upper pole of the kidney.