When is this procedure indicated?
Cytoreductive nephrectomy is usually performed for malignant renal tumors that have invaded the renal vein, causing neoplastic thrombosis. Radical nephrectomy is aimed at removing the tumor mass surrounded by healthy tissue in order to reduce the risk of cancer cells remaining in the operating field, which can cause recurrence, that is, the reformation of the tumor masses where the kidney used to be.
How is it performed?
Radical nephrectomy involves the removal of the kidney and adrenal gland along with the perirenal tissue and the outer membrane of the latter, called Gerota's fascia and a neoplastic thrombus (some tumors may have the characteristic feature of invading the vena cava through the endoluminal canal, causing neoplastic thrombosis along the ascending vena cava to the right atrium). Thus, the kidney, adrenal gland and their surrounding structures are removed in one block with the removal of the renal vein with a thrombus and possible partial / complete removal of the cavity wall. Finally, the retroperitoneal lymph nodes are also removed, depending on the side of the neoplasm, in order to correctly determine the stage of the disease. This operation involves an anterior abdominal incision from the sternum to a few centimeters below the navel.
Possible complications include anemia, elimination of the need for the spleen (splenectomy), damage to the pancreas, liver and intestines, pneumothorax, infection of superficial or deep wounds with the possibility of sepsis, renal failure, adrenal insufficiency, thromboembolic complications.