Poster session 4: Benign and Malignant renal diseases and Kidney transplant| Volume 8, ISSUE 8, P676, September 2009

C55 The impact of selected surgical approach on postoperative morbidity in the management of advanced renal cell carcinoma (pT3, pT4)

      Introduction and Objectives

      The aim of our work is a comparison of postoperative morbidity, assessment of the importance of choice of surgical approach – thoracophrenolaparotomy (TFL), lumbotomy (LT) and simple laparotomy (LP) – with regard to postoperative quality of life of the patients. Renal cell carcinoma (RCC) has worst prognosis among urological cancers – killing urologic malignancy. In recent years it became an object of extreme interest due to the increasing incidence and also introduction of target therapy. We are also highlighting the new aspects of the disease obtained from compilation of information from recent clinical trials.

      Material and Methods

      Study included a total of 160 patients, who undergone surgical treatment in our departments during the years 2000–2008 for advanced RCC (pT3, pT4). Patients were divided into 3 groups. Each patient included in the study filled out questionnaires: 1. regarding the evaluation of postoperative pain (pain assessment using a standardized questionnaire and visual analog scale) – pain in the first postoperative day, pain on the day of discharge from hospital and 30th postoperative day, 2. concerning the beginning of normal daily activities, 3. related to resumption to work. Furthermore, we evaluated postoperative complications and duration of hospitalization.


      Patients were divided into 3 groups – 30 TFL, 30 LT and 100 patients LP. 70% men, mean age 68.5 years. The results concerning postoperative morbidity – postoperative complications, pain – in the group TFL, LT resp. LP showed no statistically significant difference. We have not experienced serious complications. The average length of hospitalization in the different groups of patients: 7.3 of TFL, LT 8 days, 6.9 on LP. Most of the patients return to work after 12 weeks.


      Even if postoperative morbidity appears to be higher after TFL than after LT or LP for larger pleural and diaphragmatic opening, this presumption has not been confirmed in our study. If TFL is indicated (especially in large upper pole tumors, extension to the adrenal gland) it is more comfortable, because of the optimum exposure to operational field to the surgeon – allowing for faster performance with less blood loss.