Nephrectomy - Wikipedia, the free encyclopedia

18/04/15 06:07

Nephrectomy
From Wikipedia, the free encyclopedia

Nephrectomy is the surgical removal of

a kidney. See below for partial
nephrectomy.

Nephrectomy
Intervention

Contents
1 History
2 Indications
3 Procedure
4 After care
5 Partial Nephrectomy
5.1 History
5.2 Indications
5.3 Procedure
5.4 Complications
5.5 Cancer Control,
Quality of Life and
Survival

Before and after a radical nephrectomy

6 See also

ICD-9CM

55.5 (http://icd9cm.chrisendres.com/index.php?
srchtype=procs&srchtext=55.5&Submit=Search&action=search)

7 References

MeSH

D009392

8 Links and Sources

OPS-

5-554 (http://ops.icd-code.de/ops/code/5-554.html)

301 code:

History
The first successful nephrectomy was
performed by the German surgeon
Gustav Simon on August 2, 1869 in
Heidelberg. Simon practiced the
operation beforehand in animal
experiments. He proved that one healthy
kidney can be sufficient for urine
excretion in humans.

Partial Nephrectomy
Intervention

Indications
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There are various indications for this

procedure, such as renal cell carcinoma,
a non-functioning kidney (which may
cause high blood pressure) and a
congenitally small kidney (in which the
kidney is swelling, causing it to press on
nerves which can cause pain in unrelated
areas such as the back). Nephrectomy for
renal cell carcinoma is rapidly being
modified to allow partial removal of the
kidney. Nephrectomy is also performed
for the purpose of living donor kidney
transplantation. A nephroureterectomy is
the removal of a kidney and the entire
ureter and a small cuff of the bladder for
urothelial cancer of the kidney or ureter.

Procedure

Before and after a partial nephrectomy

ICD-9-

55.4 (http://icd9cm.chrisendres.com/index.php?

CM

srchtype=procs&srchtext=55.4&Submit=Search&action=search)

MeSH

D009392

OPS5-554 (http://ops.icd-code.de/ops/code/5-554.html)
301 code:

The surgery is performed with the patient under general anesthesia. A

kidney can be removed through an open incision or laparoscopically.
For the open procedure, the surgeon makes an incision in the side of the
abdomen to reach the kidney. Depending on circumstances, the incision
can also be made midline. The ureter and blood vessels are
disconnected, and the kidney is then removed. The laparoscopic
approach utilizes three or four small (510 mm) cuts in the abdominal
and flank area. The kidney is completely detached inside the body and
Laparoscopic nephrectomy
then placed in a bag. One of the incisions is then expanded to remove
the kidney for cancer operations. If the kidney is being removed for
other causes, it can be morcellated and removed through the small incisions. Recently, this procedure is
performed through a single incision in the patient's belly-button. This advanced technique is called single port
laparoscopy.
In January 2009, a woman who had previously had a hysterectomy was able to donate a kidney and have it
removed through her vagina. The operation took place at Johns Hopkins Medical Center. This is the first time a
healthy kidney has been removed via this method, though it has been done in the past for nephrectomies carried
out due to pathology. Removing organs through orifices prevents some of the pain of an incision and the need

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for a cosmetically unappealing larger scar. Any advance which leads to a decrease in pain and scarring has the
potential to boost donor numbers.[1] This operation also has taken place at the Cleveland Clinic. The first
transvaginal Nephrectomy actually took place at the Cleveland Clinic in Cleveland Ohio.[2]
For some illnesses, there are alternatives today that do not require the extraction of a kidney. Such alternatives
include renal embolization[3] for those who are poor candidates for surgery, or partial nephrectomy if possible.
Occasionally renal cell cancers can involve adjacent organs, including the IVC, the colon, the pancreas or the
liver. If the cancer has not spread to distant sites, it may be safely and completely removed surgically via open
or laparoscopic techniques.[4]

After care
Pain medication is often given to the patient after the surgery because of pain at the site of the incision. An IV
with fluids is administered. Electrolyte balance and fluids are carefully monitored, because these are the
functions of the kidneys. It is possible that the remaining kidney does not take over all functionality. A patient
has to stay in the hospital between 2 and 7 days depending on the procedure and complications.

Partial Nephrectomy
Partial Nephrectomy is the surgical removal of a kidney tumor along with a thin rim of normal kidney, with
the two aims of curing the cancer and preserving as much normal kidney as possible.

History
Czerny first described a partial nephrectomy in 1890.[5] However, due to limited x-ray and imaging capabilities
to find small kidney tumors and significant complications associated with early operations it was largely
abandoned. More recently, with improved imaging, improved surgical techniques and increased kidney tumor
detection, partial nephrectomy is performed more often.[6]

Indications
A partial nephrectomy should be attempted when there is a kidney tumor in a solitary kidney, when there are
kidney tumors in both kidneys, or when removing the entire kidney could result in kidney failure and the need
for dialysis.
Partial Nephrectomy is also the standard of care for nearly all patients with small renal masses (<4 cm in
size).[6] Most renal masses between 4-7 centimeters can also be treated by partial nephrectomy if they are
located in the proper position.[7] Renal masses larger than 7 centimeters are generally treated with radical
nephrectomy unless the tumor occurs in a solitary kidney, there are tumors on both sides or kidney function is
bad. Patients who are told their tumors are too big or too hard for a partial nephrectomy may want to seek
another opinion because surgeons who take care of many patients with kidney cancer are more often able to
spare the kidney than those who only see a few cases.[8]
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Procedure
A partial nephrectomy is performed with a patient under general anesthesia as well. A partial nephrectomy can
be performed through an open, laparoscopic[9] or robotic approach. The patient is typically placed on the
operating room bed lying on the side opposite the kidney tumor. The goal of the procedure is to remove the
kidney tumor along with a thin rim of normal kidney tissue. Because the kidneys clean the blood, all blood
eventually flows through the kidneys and 25% of it will go into the kidneys with each heart beat. In order to
safely remove the kidney tumor, the blood flow to the kidney is often temporarily blocked off. The tumor is then
cut out and the surgeon must sew the remaining kidney back together. Partial nephrectomy is often an
alternative to complete or radical nephrectomy for renal cell cancer.

Complications
Patients who undergo partial nephrectomy experience complications around 15-25% of the time.[9][10] The most
common complications are bleeding, infection and urinary leak.[9]

Cancer Control, Quality of Life and Survival

Partial nephrectomy offers the same chance of cure from the renal cell cancer as radical nephrectomy.[6][7] This
was confirmed in a recent meta-analysis.[11] Partial nephrectomy has been shown to maintain kidney function
better than total removal.[7] There is some debate whether this preservation of kidney function leads to longterm benefits to the patient.[12] Some studies have found that patients treated by partial nephrectomy live longer
than patients who had their whole kidney removed.[7] Other studies have found the opposite.[13] Partial
nephrectomy has been associated with better quality of life compared to radical nephrectomy.[14]

See also
Kidney donation

References
1. Donor kidney removed via vagina (http://news.bbc.co.uk/1/hi/health/7867837.stm), BBC News, 3 February 2009
2. "Cleveland Clinic performs first transvaginal kidney removal, plans a second"
(http://blog.cleveland.com/medical/2009/03/cleveland_clinic_performs_firs.html). The Plain Dealer. March 30, 2009.
|first1= missing |last1= in Authors list (help)

3. Hom, David; Eiley, David; Lumerman, Jeffrey H.; Siegel, David N.; Goldfischer, Evan R.; Smith, Arthur D. (1999).
"Complete Renal Embolization As an Alternative to Nephrectomy". The Journal of Urology 161 (1): 247.
doi:10.1016/S0022-5347(01)62049-4 (https://dx.doi.org/10.1016%2FS0022-5347%2801%2962049-4). PMID 10037359
(https://www.ncbi.nlm.nih.gov/pubmed/10037359).
4. Crotty, KL; MacAluso Jr, JN (2000). "Partial colectomy required for resection of renal cell carcinoma: A case report and

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review of treatment options for locally advanced disease". The Journal of the Louisiana State Medical Society 152 (3):
11923. PMID 10851826 (https://www.ncbi.nlm.nih.gov/pubmed/10851826).
5. Czerny HE (cited by Herczel E): Ueber nierenextirpation bietr. Klin Khirurg 1890;6:485.
6. Campbell, Steven C.; Novick, Andrew C.; Belldegrun, Arie; Blute, Michael L.; Chow, George K.; Derweesh, Ithaar H.;
Faraday, Martha M.; Kaouk, Jihad H.; Leveillee, Raymond J.; Matin, Surena F.; Russo, Paul; Uzzo, Robert G.; Practice
Guidelines Committee of the American Urological Association (2009). "Guideline for Management of the Clinical T1
Renal Mass". The Journal of Urology 182 (4): 12719. doi:10.1016/j.juro.2009.07.004
(https://dx.doi.org/10.1016%2Fj.juro.2009.07.004). PMID 19683266 (https://www.ncbi.nlm.nih.gov/pubmed/19683266).
7. Weight, Christopher J.; Larson, Benjamin T.; Fergany, Amr F.; Gao, Tianming; Lane, Brian R.; Campbell, Steven C.;
Kaouk, Jihad H.; Klein, Eric A.; Novick, Andrew C. (2010). "Nephrectomy Induced Chronic Renal Insufficiency is
Associated with Increased Risk of Cardiovascular Death and Death from Any Cause in Patients with Localized cT1b
Renal Masses". The Journal of Urology 183 (4): 131723. doi:10.1016/j.juro.2009.12.030
(https://dx.doi.org/10.1016%2Fj.juro.2009.12.030). PMID 20171688 (https://www.ncbi.nlm.nih.gov/pubmed/20171688).
8. Weight, Christopher J.; Crispen, Paul L.; Breau, Rodney H.; Kim, Simon P.; Lohse, Christine M.; Boorjian, Stephen A.;
Thompson, R. Houston; Leibovich, Bradley C. (2013). "Practice-setting and surgeon characteristics heavily influence the
decision to perform partial nephrectomy among American Urologic Association surgeons". BJU International 111 (5):
7318. doi:10.1111/j.1464-410X.2012.11112.x (https://dx.doi.org/10.1111%2Fj.1464-410X.2012.11112.x).
PMID 22502641 (https://www.ncbi.nlm.nih.gov/pubmed/22502641).
9. Gill, Inderbir S.; Kavoussi, Louis R.; Lane, Brian R.; Blute, Michael L.; Babineau, Denise; Colombo Jr, J. Roberto;
Frank, Igor; Permpongkosol, Sompol; Weight, Christopher J.; Kaouk, Jihad H.; Kattan, Michael W.; Novick, Andrew C.
(2007). "Comparison of 1,800 Laparoscopic and Open Partial Nephrectomies for Single Renal Tumors". The Journal of
Urology 178 (1): 416. doi:10.1016/j.juro.2007.03.038 (https://dx.doi.org/10.1016%2Fj.juro.2007.03.038).
PMID 17574056 (https://www.ncbi.nlm.nih.gov/pubmed/17574056).
10. Kim, Simon P.; Leibovich, Bradley C.; Shah, Nilay D.; Weight, Christopher J.; Borah, Bijan J.; Han, Leona C.; Boorjian,
Stephen A.; Thompson, R. Houston (2013). "The relationship of postoperative complications with in-hospital outcomes
and costs after renal surgery for kidney cancer". BJU International 111 (4): 5808. doi:10.1111/j.1464410X.2012.11122.x (https://dx.doi.org/10.1111%2Fj.1464-410X.2012.11122.x). PMID 22564425
(https://www.ncbi.nlm.nih.gov/pubmed/22564425).
11. Kim, Simon P.; Murad, M. Hassan; Thompson, R. Houston; Boorjian, Stephen A.; Weight, Christopher J.; Han, Leona
C.; Erwin, Patricia J.; Costello, Brian A.; Chow, George K.; Leibovich, Bradley C. (2012). "Comparative Effectiveness
for Survival and Renal Function of Partial and Radical Nephrectomy for Localized Renal Tumors: A Systematic Review
and Meta-Analysis". The Journal of Urology. doi:10.1016/j.juro.2012.10.026
(https://dx.doi.org/10.1016%2Fj.juro.2012.10.026).
12. Weight, Christopher J.; Miller, David C.; Campbell, Steven C.; Derweesh, Ithaar H.; Lane, Brian R.; Messing, Edward
M. (2013). "The Management of a Clinical T1b Renal Tumor in the Presence of a Normal Contralateral Kidney". The
Journal of Urology 189 (4): 1198202. doi:10.1016/j.juro.2013.01.030
(https://dx.doi.org/10.1016%2Fj.juro.2013.01.030). PMID 23337186 (https://www.ncbi.nlm.nih.gov/pubmed/23337186).
13. Van Poppel, Hendrik; Da Pozzo, Luigi; Albrecht, Walter; Matveev, Vsevolod; Bono, Aldo; Borkowski, Andrzej;
Colombel, Marc; Klotz, Laurence; Skinner, Eila; Keane, Thomas; Marreaud, Sandrine; Collette, Sandra; Sylvester,
Richard (2011). "A Prospective, Randomised EORTC Intergroup Phase 3 Study Comparing the Oncologic Outcome of

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Elective Nephron-Sparing Surgery and Radical Nephrectomy for Low-Stage Renal Cell Carcinoma". European Urology
59 (4): 54352. doi:10.1016/j.eururo.2010.12.013 (https://dx.doi.org/10.1016%2Fj.eururo.2010.12.013).
PMID 21186077 (https://www.ncbi.nlm.nih.gov/pubmed/21186077).
14. Clark, Peter E; Schover, Leslie R; Uzzo, Robert G; Hafez, Khaled S; Rybicki, Lisa A; Novick, Andrew C (2001).
"Quality of life and psychological adaptation after surgical treatment for localized renal cell carcinoma: Impact of the
amount of remaining renal tissue". Urology 57 (2): 2526. doi:10.1016/S0090-4295(00)00927-4
(https://dx.doi.org/10.1016%2FS0090-4295%2800%2900927-4). PMID 11182331
(https://www.ncbi.nlm.nih.gov/pubmed/11182331).

Links and Sources

Drawings of the steps of the procedure
(http://www.nlm.nih.gov/medlineplus/ency/presentations/100069_1.htm)
MedlinePlus Medical Encyclopedia: Nephrectomy
(http://www.nlm.nih.gov/medlineplus/ency/article/003001.htm)
Explanation of the surgery, the risks and the recovery
(http://www.surgerydoor.co.uk/advice/operations/nephrectomy-kidney-removal/?locale=en)
Retrieved from "http://en.wikipedia.org/w/index.php?title=Nephrectomy&oldid=640673547"
Categories: Surgical oncology Surgical removal procedures Urologic surgery
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