Mini-subcostal incision technique for open radical nephrectomy: A practical alternative for complex renal masses

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Complex renal masses often require challenging surgical interventions.
• Traditional open and minimally invasive surgery (MIS) have limitations for certain cases.
• Preserving open nephrectomy skills is crucial for managing selected complex renal masses.

Purpose of the Study:

• To describe the mini-subcostal open radical nephrectomy (msRN) technique.
• To evaluate the renal function, perioperative, and oncological outcomes of msRN.
• To present msRN as a practical alternative for complex renal masses.

Main Methods:

• Retrospective analysis of patients undergoing msRN from 2013 to 2016.
• Utilized an 8 to 12 cm mini-subcostal incision.
• Analyzed clinicopathologic, perioperative, renal function metrics, and survival using statistical models.

Main Results:

• 193 patients with complex renal masses (median tumor size 7.2 cm, 67.9% ≥pT3) were analyzed.
• Median incision length was 10 cm; median operative time was 123 minutes.
• Median estimated glomerular filtration rate (eGFR) decreased by 34.1% with no dialysis requirements; 30-day complication rate was 18.1%.

Conclusions:

• The msRN technique provides favorable outcomes for complex renal masses.
• msRN is a practical alternative to traditional open and MIS approaches.
• This approach supports the continued relevance of open surgical techniques for specific renal cases.