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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med Chin    2009, Vol. 3 Issue (2) : 191-196     DOI: 10.1007/s11684-009-0026-5
RESEARCH ARTICLE |
Retrospective study of the efficacy and complication of thoracoabdominal incision for nephrectomy: a comparison with flank approach
Minggen YANG, Xiaokun ZHAO()
Department of Urology, Second Xiangya Hospital, Central South University, Changsha 410011, China
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Abstract  

This retrospective study was performed to compare the outcome of thoracoabdominal incision versus flank incision for radical nephrectomy in the patients with large renal tumors. A questionnaire assessing postoperative pain, administration of pain medications and the return to activities and work was sent to the patients who undergoing radical nephrectomy through the 11th rib (group 1: underwent flank incision, including 96 patients) or the 9th to 10th rib (group 2: undergoing thoracoabdominal incision, including 98 patients) from 2003 to 2007 in our hospital. A case retrospective analysis assessing operation time, perioperative hemorrhage volume, size of tumor, success in the treatment of tumor thrombus in renal vein or vena cava, time length of presence of drainage tube, postoperative analgesia usage and length of stay was conducted in patients whose questionnaires were returned. A total of 56 patients (58%) in group 1 and 60 (61%) in group 2 responded to the questionnaire. Time lengths of operation and presence of abdominal drainage tube were shorter in group 2 than those in group 1. Perioperative hemorrhage volume in group 2 was obviously less than that in group 1. The mean size of tumors in group 1 was significantly smaller than that in group 2 (P< 0.0005). The success rate of treating thrombus in renal vein or vena cava in group 2 was significantly higher than that in group 1 (P<0.05). Lengths of off-bed time and stay were the same in both groups. There were no differences between groups in terms of pain severity on postoperative day 1, on day of discharge and 1 month postoperatively (P >0.05). There were no significant differences between groups in the time following surgery when pain completely disappeared, when pain medications were discontinued, and when the patient returned to daily activities and work (P >0.05). The thoracoabdominal incision provides excellent exposure and allows for early vascular control. Efficacy and complication was comparable for thoracoabdominal and flank incisions in terms of incisional pain, analgesic requirements after discharge and return to normal activities.

Keywords surgery      renal tumors      nephrectomy     
Corresponding Authors: ZHAO Xiaokun,Email:zhaoxiaokun50@163.com   
Issue Date: 05 June 2009
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-009-0026-5     OR     http://academic.hep.com.cn/fmd/EN/Y2009/V3/I2/191
groupsoperation time/minperioperative hemorrhage volume/mLsize of tumors/cmsuccess rate of treating tumor thrombus in renal vein or vena cavapatients treated with analgesia on postoperative day 1 (n)time length of presence of abdominal drainage tube/dtime of off-bed/dhospital stay/d
group 1169.8± 13.3209.9±12.713.8±3.569.23% (18/26)403.82±0.674.79±0.699.39±1.55
group 2156.4±10.8150.2±10.121.8±3.295.00% (38/40)423.27±0.324.97±0.729.53±1.63
P value&lt; 0.0001&lt; 0.0005&lt; 0.0005&lt; 0.05&gt; 0.9000.0010.6950.516
Tab.1  The comparison of surgery and postoperative recovery between thoracoabdominal and flank incisions
pain severitypostoperative day 1discharge day1 month postoperatively
Severe
group 140 (71)14 (25)4 (7)
group 242 (70)18 (30)6 (10)
Moderate
group 114 (25)18 (32)8 (14)
group 214 (23)20 (33)12 (20)
mild/none
group 12 (4)24 (43)44 (79)
group 24 (7)22 (37)42 (70)
P value&gt; 0.5&gt; 0.5&gt; 0.25
Tab.2  Pain score distribution according to visual analog scale at different postoperative time
, %
groupslasting days of postoperative paindays of postoperative analgesia usetime from surgery to return to daily activities/dtime from surgery to return to work/d
group 122.39±10.413.04±4.2624.61±5.2430.29±6.31
group 224.23±10.863.07±4.0824.87±3.5031.47±5.96
P value0.5130.9780.0520.630
Tab.3  The cases of postoperative follow-up of thoracoabdominal and flank incisions
group 1group 2
How long did the pain last after the operation until it completely disappeared? (P=0.513)
within 1 week4 (7.1)4 (6.7)
between 1-2 weeks10 (17.9)8 (13.3)
between 2-4 weeks24 (39.3)26 (43.3)
between 4-8 weeks18 (35.7)22 (36.7)
Total56 (100)60 (100)
When did you discontinue pain medication following surgery? (P = 0.978)
within 1 week42 (75.0)44 (73.3)
between 1-2 weeks12 (21.4)14 (23.3)
between 2-4 weeks2 (3.6)2 (3.4)
Total56 (100)60 (100)
How long following the operation were you able to return to your regular daily activities? (P = 0.052)
within 2 weeks0 (0)0 (0)
between 2-3 weeks20 (35.7)16 (26.7)
between 3-4 weeks22 (39.3)30 (50.0)
after 4 weeks14 (25.0)14 (23.3)
Total56 (100)60 (100)
How long after the operation were you able to return to work? (P = 0.630)
within 2 weeks0 (0)0 (0)
between 2-4 weeks24 (42.9)28 (46.7)
between 4--6 weeks28 (50.0)26 (43.3)
after 6 weeks4 (7.1)6 (10.0)
Total56 (100)60 (100)
Tab.4  Distribution of responses in regard to pain, pain medication, returning to normal activities and work
, %
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