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Definition:
Open cytoreductive
nephrectomy is the exact same operation as an open radical nephrectomy.
However, the open cytoreductive nephrectomy is done in the setting
of kidney cancer that has extended outside of the kidney and its
surrounding tissues. The extent of the cancer may be limited to
tissues in the area around the kidney known as the lymph nodes,
or the kidney cancer may have more extensively spread to other organs
such as the lung or liver.
Considering an open cytoreductive nephrectomy implied
that, prior to the surgery, your doctor already knows that the cancer
has spread outside the kidney to another organ and therefore removal
of the kidney alone is not going to result in cure. After the cytoreductive
other systemic treatment strategies will be needed to increase the
chance of cure and to extend life as much as possible.
Open cytoreductive nephrectomy was not performed in
the past if the patient did not have symptoms such as pain or bleeding.
However, it has been proven in two separate large clinical trials
that open cytoreductive nephrectomy afford patients a slight improvement
in survival and will extend life for a period of time that is usually
in the range of three months to a year.
Technique:
Open cytoreductive
nephrectomy involves removal of the entire kidney but may also require
the removal of adjacent organs such as the intestines, pancreas,
spleen, or parts of the liver. The open cytoreductive nephrectomy
is often a very technically challenging operation as the kidney
cancer is outside the normal area of the kidney and can make control
of the blood vessels that must be controlled to remove the kidney
cancer quite difficult. Similarly, the cancer may have grown into
nearby structures such as the liver, pancreas and spleen. As such,
it is very important that the surgeon performing this procedure
be specially trained in kidney cancer surgery of this type. Additionally,
open cytoreductive nephrectomy should be performed at medical centers
that have advanced surgeons and facilities that may be required
in addition to the Urologist to optimize each patient’s outcome.
Candidates:
Candidates for open cytoreductive radical nephrectomy include
relatively healthy patients with kidney cancer that has extended
beyond the kidney and its immediate surrounding tissues (metastatic
kidney cancer). The operation tends to benefit patients who can
perform basic activities of daily living by themselves and who do
not have symptoms from their kidney cancer. Before undergoing this
type of surgery, patients should discuss their situation with a
Urologist who specializes in advanced kidney cancer and who has
extensive experience with this open cytoreductive nephrectomy.
Advantages / Disadvantages:
While open cytoreductive nephrectomy is a large operation
that requires significant time for recovery, it can offer healthier
patients with kidney cancer that has spread beyond the area of the
kidney and its immediate surrounding tissues a chance for cure.
Certainly, the open cytoreductive nephrectomy has been shown to
extend the life of patients with kidney cancer that has spread to
other parts of the body. The amount of time that open cytoreductive
nephrectomy will extend life is variable, but will typically range
from several months to a year.
Follow-up:
Follow-up from an open cytoreductive radical nephrectomy
involves an extended recovery that usually requires a couple of
months for the patients to achieve full activity. Additionally,
after recovery from the surgery, patients require treatment in a
multidisciplinary cancer center using the state of art systemic
or total body therapies.
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