Open Radical Nephrectomy:35 years of experience at the "Luciano Giuliani" Urological Department of the University of Genoa

Objective: Radical nephrectomy remains the gold standard for surgically
resectable kidney neoplasms >4 cm and, in selected cases, also in presence
of metastatic disease. We reviewed the records of the patients having
surgery at the University of Genoa in the last 35 yr.
Methods: We have retrospectively assessed all the radical nephrectomies
performed between 1970 and 2005. Among tumours of the kidney subjected
to surgical treatment during this period, we found 1105 cases of histologically
proven renal cell carcinoma (RCC), 965 of which had records available for the
study. The number of cases per year, symptoms at diagnosis, surgical
strategy, staging of the tumour, and survival were reviewed.
Results: Among 965 patients, radical nephrectomy was performed in 825
(85.5%) with a mean age of 61.26 yr (range, 20–88 yr) and partial nephrectomy
in 140 (14.5%) with a mean age of 59.4 yr (range, 20–86 yr). Metastases at
diagnosis were present in 81 patients (9.8%). The surgical approach was
transperitoneal in 484 (58.6%) and extraperitoneal in 341 (41.4%) of the 825
patients. Atransperitoneal approach was preferred for all tumours10 cmin
diameter. No postoperative deaths occurred due to technical complications
but 15 patients (1.8%) died in the 30 d following the operation due to
myocardial infarction, pulmonary embolus, or sepsis. At the last followup,
the 5-yr overall survival rate was 56% and the 5-yr cancer-specific
survival and disease-free survival rates were 70% and 65%, respectively.
Conclusions: The incidence of RCC has slowly increased in recent years in our
department. Surgical extirpation remains the most widely accepted and
potentially curative treatment option for renal neoplasms with a good
efficacy and low mortality and morbidity rates.