Place of Open Radical Nephrectomy, in the Era of Laparoscopy in Subsaharian Africa

Abstract

Introduction: Kidney cancer is discovered in Africa often at advanced or locally advanced stages. These patients could be treated by radical nephrectomy or cytoreductive nephrectomy. Open surgery still retains its place due to the technical difficulties which are linked to the stage of the tumors in this era where laparoscopy is becoming the gold standard. Through this study, we wanted to highlight the advanced stages of patients operated by open surgery in our institution rather than laparoscopy, however, with good results. Patients and Method: It was a retrospective study over a period of 5 years. Were included all patients in whom radical nephrectomy had been performed during this period. Results: Thirty-five (35) open radical nephrectomies for kidney cancer were performed. The average tumor size was 11.6 cm (±3.4 cm). The mean operating time was 169 min ± 63.4 min with extremes of 115 min (1 h 55 min) and 360 min (6 h). This duration was longer for large tumors (p = 0.002). Intraoperative incidents occurred in 4 patients (11.4%); it was a vena cava injury (02) and a spleen injury (02). Blood loss was estimated on average at 535 ml. The mean follow-up time was 19 ± 11 months. The overall survival rate was 90% at 3 months, 53% at 12 months and 35.4% at 24 months. Conclusion: The large size of kidney tumor found in Africa may constitute an obstacle to performing nephrectomies by laparoscopy. However, mastering the laparoscopic technique with appropriate equipment can help reduce operative morbidity.