Abstract

Introduction: Renal cell carcinoma (RCC) is the most common malignancy of the kidney and radical

nephrectomy (RN) or nephron sparing surgery (NSS) has been the standard treatment. Due to the

technological developments and the increasing use of the imaging modalities like abdominal ultrasound (US),

computed tomography (CT) and magnetic resonance imaging (MRI), increasing numbers of RCCs have been

diagnosed in recent years. Therefore, the number of surgical treatments has also increased. Intraoperative

organ injuries during RN and NSS could occur during surgery. The aim of this retrospective study was to

evaluate the intraoperative organ injuries occurred during the surgical management of kidney tumors.

Materials and Methods: The data of 108 (73 male, 35 female) consecutive patients with the diagnosis of

kidney tumor who were treated at our institution were reviewed retrospectively. One hundred and one

patients underwent RN and 7 underwent NSS. Preoperative staging included physical examination, hemogram

and biochemistry, abdominal US, chest x-ray, intravenous urography, abdominal CT and abdominal MRI.

Radical nephrectomy was the standard treatment of choice in patients with kidney tumors. NSS was

performed for the tumors with a peripheric location and smaller than 4 cm. Other indications for NSS were

having a single tumor bearing kidney, bilateral renal kidney tumors, renal insufficieny, having nephrolithiasis

in the opposite kidney or von Hippel-Lindau disease.

Results: Of the 108 patients, 101 had RN and 7 had NSS. Median age of the patients was 58 (range, 20-82)

years. Organ injuries were detected in 22 (20.4%) patients. The most frequent intraoperative organ injuries

were liver and spleen injuries. Twenty of the patients who underwent RN (%19.8) and 2 (%28.5) of the

patients who underwent NSS had organ injuries. Of the patients with intraoperative organ injuries 12 (54.5%)

had right sided and 10 (45.5%) had left sided kidney tumors. The mean tumor size was similar (6.8 cm) in

patients with and without organ injuries and no significant correlation was detected regarding the tumour size

and laterality (p=0.30 and p=0.38, respectively). Of the patients with organ injuries, tumor size was 7.6 cm in

the right sided tumors and 5.8 cm in left sided ones (p=0.22). Out of 22 patients with organ injuries,

transperitoneal anterior subcostal (Chevron) incision was performed in 17 patients and flank incision was

performed in 5 patients. Of the 4 patients with pleural injury, 3 had flank incision and 1 had Chevron incision.

Four vascular and 7 liver injuries were occurred in patients who had undergone surgery with Chevron

incision.

Conclusion: A variety of organ injuries can occur during the surgical management of kidney tumors.

These injuries could be due to the surgeon, the surgical technique and the features of the tumor.

Intraoperative organ injuries can be minimized by using a well planned and careful surgical technique as well

as early diagnosis and repair of these injuries.