[Pitfalls and outcome of nephrectomy for patients with polycystic kidney disease: Peri- and postoperative results].

BACKGROUND: There are several indications to perform nephrectomy in patients with polycystic kidney disease (PCKD), including pain, hematuria, hypertension, and infections. Operative access and time to surgery are discussed controversially in the literature. We retrospectively reviewed our peri- and postoperative experiences in the surgical management of patients with PCKD and compared them to minimally invasive procedures. MATERIAL AND
METHOD: Between January 2003 and January 2010, 40 patients with PCKD underwent simple (n=25) or radical nephrectomy (n=4). In 11 patients a bilateral nephrectomy was performed. The mean patient age was 59 (45-69) years. Indications for nephrectomy were flank/abdominal pain (n=19); gross recurrent hematuria (n=9), septic constellation (n=8), and suspected malignancy (n=4). There were 26 male and 14 female patients. All procedures were performed with a retroperitoneal approach or a chevron incision.
RESULTS: A total of 51 nephrectomies were performed on 40 patients with a mean surgical time of 115 (60-310) min. There was one significant intraoperative complication. The mean length of the specimens was 45 (20-87) cm and mean weight was 3.5 (0.8-22.3) kg. Histological examination of the specimens identified renal cell carcinoma (RCC) in three of the four cases. In the other kidneys the pathologists described a polycystic kidney disease. Two significant complications (5%) occurred in the postoperative period: bleeding from an intercostal artery and nonocclusive mesenteric ischemia (NOMI).
CONCLUSION: Although technically demanding due to size and weight, retroperitoneal nephrectomy can be performed safely in patients with PCKD. However, surgery might be associated with unusual complications such as NOMI due to nephrectomy. Compared to minimally invasive procedures there is reduced morbidity, so at least in larger specimens we recommend open surgery.