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Definition:
Open radical nephrectomy is defined as removal of the entire
kidney with surrounding fat and adrenal gland via an open flank
or abdominal incision.
Technique:
Under general anesthesia, the kidney is removed along with
the surrounding structures such as the adrenal gland and lymph nodes.
Occasionally, open radical nephrectomy requires removal of a rib
or placement of a drainage tube within the chest cavity to complete
the operation.
Candidates:
Candidates for open radical nephrectomy are generally patients
with large kidney cancers that are greater than 10 cm (approximately
4 inches) in size. Also, patients who have had extensive prior surgery
are good candidates for open radical nephrectomy as laparoscopy
can be very challenging if there is a large amount of scarring in
the space around the kidney. Finally, if there is evidence that
the kidney cancer has involvement of organs around the kidney, then
open radical nephrectomy is often the best procedure.
Advantages / Disadvantages:
The advantages of open radical nephrectomy is that the
larger incision that is created allows the surgeon to deal with
complex cancers, which involve structures around the kidney. Kidney
cancer can involve organs around the kidney such as the pancreas,
spleen, and liver. With open radical nephrectomy, the surgeon will
have the best ability to access and control these structures if
they are involved by the kidney cancer.
The disadvantages of open radical nephrectomy are
predominantly related to short-term post-operative pain control
as the procedure is four to five times more painful than the laparoscopic
radical nephrectomy. Additionally, in comparison to laparoscopic
radical nephrectomy, the open radical nephrectomy is typically associated
with a longer recovery period and complete recovery.
The Procedure:
The procedure involves total removal of the kidney with
or without the adrenal gland and surrounding lymph nodes by traditional
surgical techniques.
Follow-up:
The standard follow-up for open radical nephrectomy is
dependent on the individual patient’s pathology report as different
types of kidney cancer have different natural courses. Some kidney
cancers require close “surveillance” (monitoring after
the surgery) as they are more aggressive. Other types of kidney
cancer are less aggressive and can be safely followed a little less
frequently. Follow-up surveillance usually involve simple imaging
studies. In cases where the kidney cancer is thought to have spread
outside the kidney and tissues that have been removed during the
procedure, some patients are offered additional treatment. This
post-operative systemic therapy is offered and given in patients
with a high risk of disease recurrence.
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