Objective The efficacy and morbidity of thoracoabdominal incision in comparison with flank incision for radical nephrectomy are unknown. This retrospective study was performed to compare the outcome of thoracoabdominal incision versus flank incision for radical nephrectomy in patients with large renal tumors. Methods A questionnaire assessing the time of postoperative pain, use of anodyne and return to daily activities and work was sent to patients who underwent radical nephrectomy through the 11th rib (flank incision, group A, 96 patients) or the 9th to 10th rib (thoracoabdominal incision, group B, 98 patients) from 2003 to 2008 at the Second Xiangya Hospital in Changsha, China. A case retrospective analysis assessing operation time, perioperative hemorrhage volume, size of tumors, success in the treatment of tumor thrombus in renal vein or vena cava, presence of drainage-tube, postoperative analgesia usage and length of stay was done for patients whose questionnaires were returned. Results The length of operation time and the presence of abdominal drainage-tube was shorter in the thoracoabdominal incision group (group B) than in the flank incision group (group A). The perioperative hemorrhage volume in group B was less than that in group A. The mean size of tumors in group A was smaller than that in group B (Plt;0.000 5). The success rate in the treatment of thrombus in renal vein or vena cava in group B was higher than that in group A (Plt;0.05). The length of off-bed time and of hospital stay were similar in both groups. There were no significant differences between the groups in pain severity postoperative day 1, on the day of discharge and 1 month postoperatively (Pgt;0.05). There were no significant differences between the groups in the time from surgery to the complete disappearence of pain, to the discontinuation of pain medication, and to the return to daily activities and work (Pgt;0.05). Conclusion The approach of thoracoabdominal incision provides better exposure. Morbidity is comparable for thoracoabdominal and flank incisions in terms of incisional pain, analgesic requirements after discharge and return to normal activities.
ObjectiveTo systematically review the efficacy and safety of laparoscopic versus open nephrectomy in the treatment of autosomal dominant polycystic kidney disease (ADPKD). MethodsWe searched databases including MEDLINE, EMbase, The Cochrane Library (Issue 1, 2015), Web of Science, CBM and WanFang Data to collect relevant clinical studies comparing the efficacy and safety of laparoscopic versus open nephrectomy for ADPKD from inception to Jan, 2015. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies. Then, RevMan 5.4 software was used for meta-analysis. ResultsA total of six retrospective cohort studies involving 182 patients were included. The results of the meta-analysis showed that:compared with the open nephrectomy group, the average hospitalization time was shorter (MD=-4.38 days, 95%CI -5.93 to -2.83, P=0.000 01) and the blood transfusion risk was lower (OR=0.25, 95%CI 0.10 to 0.62, P=0.003) in the laparoscopic nephrectomy group. However, there was no significant difference between two groups in the incidence of overall complications (OR=0.51, 95%CI 0.24 to 1.06, P=0.07). ConclusionThe application of laparoscopic nephrectomy for ADPKD can reduce the hospitalization time and blood transfusion risk when compared with the open nephrectomy, but the two operations have similar overall complication rate. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
Objectives To systematically review the influence of positive margin on outcome after partial nephrectomy (PN). Methods CCRCT, PubMed, EMbase, Sinomed, WanFang Data and CNKI databases were electronically searched to collect clinical studies on influence of positive margin on outcome after PN from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.4 software. Results A total of 22 cohort studies involving 20 822 patients were included. The results of meta-analysis showed that positive margin after PN could increase the rate of postoperative local recurrence (OR=4.18, 95%CI 2.88 to 6.05, P<0.000 01), distant metastasis (OR=5.28, 95%CI 2.84 to 9.81,P<0.000 01) and total mortality (OR=1.54, 95%CI 1.19 to 1.99,P=0.0010). However, there were no differences on overall survival (OR=0.64, 95% CI 0.34 to 1.19, P=0.16), distant metastasis free survival (OR=0.70, 95%CI 0.26 to 1.84, P=0.46), cancer specific survival (OR=0.43, 95% CI 0.06 to 3.01, P=0.40) and disease-free survival (OR=0.81, 95%CI 0.35 to 1.85, P=0.61) between two groups. Conclusions Current evidence suggests that positive margin after PN may be associated with tumor progression, however, it may not affect patient survival. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.