If a partial nephrectomy could be done safely for a renal tumor, would radical nephrectomy be considered malpractice?

摘要

Until the broad-based introduction of ultrasound, the typical patient with renal carcinoma was presenting with either gross hematuria, flank pain, and/or palpable flank mass. These symptoms were obviously caused by large renal tumors often infiltrating Gerota's fascia or encompassing further anatomic barriers and invading adjacent organs. The surgical strategy aiming at complete tumor removal had to take into account a possible invasion of adjacent tissues and organs. Based on this hypothesis, Robson and coworkers (reference 1 in Weight et al. [1]) analyzed their data. This paper is usually cited when "radical nephrectomy" is advocated comprising en bloc removal of the entire tumor-bearing kidney within Gerota's fascia plus the ipsilateral adrenal gland. However, even that data, analyzed at a time way before modern imaging techniques, did not justify the mandatory removal of the ipsilateral adrenal gland. In this retrospective analysis, 3-yr follow-up was available for 51 of 57 patients and 5-yr follow-up was available for 30 patients: Involvement of the adrenal gland was found in 1 of 57 patients. Given these data, the dogma of radical nephrectomy including the removal of the ipsilateral adrenal gland was more "eminence" than evidence based.