William F. Braasch

Nephrectomy and nephro-ureterectomy for malignant tumors of the kidney

Abstract In general, the most practical and frequently used incision for nephrectomy and nephro-ureterectomy begins at the costovertebral angle which overlies the affected kidney, curving down toward the crest of the ilium and then paralleling the crest of the ilium, the whole incision taking the shape of a miniature hockey stick. The patient lies on the side opposite to that of the incision. Extraperitoneal removal is performed. When tumors involve the right kidney, the proximity of the retroperitoneal portion of the duodenum and the inferior vena cava should always be borne in mind, for injuries of these structures may occur, and usually are followed by serious consequences. Subsequent to operation it is of great importance that adequate intake of fluid should be maintained. Preoperative and postoperative radiation may be of considerable value as an adjunct to surgical treatment. Particularly is this true if tumors are of embryonic type, or if certain unusually large adenocarcinomas are present. Among the clinical data which influence the advisability of operation are fixation and size of the tumor, evidence of metastasis, and condition of the patient. Evidence of pulmonary metastasis should preclude operation. In the majority of cases a diagnosis can be made from the excretory urogram, providing visualization of the pelves and calices is complete.