radical nephrectomy


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nephrectomy

 [nĕ-frek´to-me]
surgical removal of a kidney, a procedure indicated when chronic disease or severe injury produces irreparable damage to the renal cells. Tumors, multiple cysts, and congenital anomalies may also necessitate removal of a kidney.
Patient Care. The surgical incision for nephrectomy can be lumbar, retroperitoneal, transabdominal, thoracic, or thoracic abdominal. Upon the patient's return from the operating room the location of the surgical wound is immediately noted, as well as whether there are any tubes or drains exiting the wound. If the thoracic cavity has been entered, the patient will have one or more chest tubes. There may also be surgical drains for removal of serosanguineous fluid from the operative site.

Dressings over the wound are checked frequently and may be reinforced to keep the patient dry, but they are not changed without a written prescription to do so. The drainage on the dressings will be blood-tinged at first but should gradually become clearer. Hemorrhage is a major complication; hence, any appearance of bright red blood or a change in the amount of drainage is reported immediately. The kidney has a very rich supply of blood directly from the vena cava and aorta, so that if a ligature should slip, there could be substantial blood loss. The vital signs are therefore monitored closely and any signs of shock reported promptly. An intravenous line should be kept open in the event a transfusion is needed.

Sometimes the drain will have a safety pin attached to its end. The pin is kept closed at all times and is never attached to the dressings, the patient's gown, or the bedclothes. When dressings are reinforced or changed, care must be taken that drains and tubes are not dislodged or pulled from the surgical incision. All tubes and drains are checked frequently to assure that they are patent and draining freely. The exception, of course, is a chest tube attached to a closed system.

Positioning of the patient will depend on the site of the incision and the preference of the physician. Some may prefer that the patient lie only on the affected side to facilitate drainage and protect the remaining kidney. Turning, coughing, and deep breathing will produce some discomfort because of the location of the incision. However, adequate aeration of the lungs is essential. One also should watch for spontaneous pneumothorax, which can occur if the thoracic cavity has been entered accidentally during surgery.

Adequate drainage from the unaffected kidney is of extreme importance. Urinary output is monitored hourly at first and then at longer intervals to be sure there is normal renal function. Fluids may be restricted immediately after surgery and gradually increased as the remaining kidney compensates for the loss of its partner. A single kidney can carry out the work of two kidneys; thus a patient can survive a nephrectomy in good health.
radical nephrectomy removal of a kidney with its fascia, the adjacent adrenal gland, and all lymph nodes in the region; done for renal cell carcinoma.

radical nephrectomy

the surgical removal of a kidney, usually performed in the treatment of cancer of the kidney.

radical nephrectomy

Surgery Excision of a kidney, the adrenal gland, adjacent lymph nodes, and other surrounding tissue
References in periodicals archive ?
Value of frozen section analysis of enlarged lymph nodes during radical nephrectomy for renal cell carcinoma.
Recurrence is defined by every new occurrence of renal cell carcinoma after radical nephrectomy local, metastatic recurrence or death from renal cell carcinoma.
Renal and cardiovascular morbidity after partial or radical nephrectomy.
Furthermore, Weight et al (15) demonstrated in their large study of patients with renal masses who had undergone extirpative surgery, partial nephrectomy or radical nephrectomy, that partial nephrectomy offers cancer specific survival equivalent to that of radical nephrectomy and is technically feasible in at least 50% of patients with cT1b tumors.
The majority of patients with situs inversus had left-sided RCC (56%) and the most common surgical intervention was an open radical nephrectomy (67%).
17) Although radical nephrectomy is the usual surgical treatment of RCC, nephron-sparing resections are more commonplace, as the preservation of renal function becomes an important consideration for the clinical outcome and quality of life in RCC survivors.
14], only 17% of all benign lesions were correctly identified as benign at routine preoperative CT scan, but 43% underwent unnecessary radical nephrectomy.
For these reasons, the intra-operative risk of radical nephrectomy and consequent dialysis was very high.
1) This recommendation is supported by numerous retrospective studies, which have demonstrated its superior functional and survival outcomes and at least equivalent cancer control relative to radical nephrectomy (RN).
On gross examination, the left radical nephrectomy specimen measured 14 x 8 x 5cm and weighed 410 grams.
A right radical nephrectomy and interaortic caval node lymphadenectomy were performed.