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Open Mini-Flank Partial Nephrectomy: An Essential Contemporary Operation
Paul Russo,Roy Mano 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.9
Secondary to the widespread use of the modern imaging techniques of computed tomography,magnetic resonance imaging, and ultrasound, 70% of renal tumors today aredetected incidentally with a median tumor size of less than 4 cm. Twenty years ago,all renal tumors, regardless of size were treated with radical nephrectomy (RN). Elective partial nephrectomy (PN) has emerged as the treatment of choice for smallrenal tumors. The basis of this paradigm shift is three major factors: (1) cancer specificsurvival is equivalent for T1 tumors (7 cm or less) whether treated by PN or RN; (2)approximately 45% of renal tumors have indolent or benign pathology; and (3) PN preventsor delays the onset of chronic kidney disease, a condition associated with increasedcardiovascular morbidity and mortality. Although PN can be technically demandingand associated with potential complications of bleeding, infection, and urinaryfistula, the patient derived benefits of this operation far outweigh the risks. Wehave developed a "mini-flank" open surgical approach that is highly effective and, coupledwith rapid recovery postoperative care pathways associated with a 2-day lengthof hospital stay.
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