Synchronous resections of intra-abdominal pathologies during radical nephrectomy: a case-linked cohort study evaluation of outcomes

Objectives: We report the outcomes of radical nephrectomy with synchronous surgical resection of intra-abdominal pathologies to guide practice. Patients and methods: The data of patients requiring radical nephrectomy and surgical resection of a synchronous intra-abdominal pathology over a period of 12 years was extracted on pre-designed data extraction sheets from the case notes and included: age, sex, nature of second intra-abdominal pathology, intra-operative and postoperative details including complications, recurrence rate and survival on follow-up. Results: Two hundred and ninety patients underwent radical nephrectomy for non-metastatic renal cell carcinoma between January 1995 and January 2007. Amongst these, 30 patients (12%) had an additional surgical resection of a second intra-abdominal pathology at the time of radical nephrectomy. Fifteen underwent radical nephrectomy and surgical resection of a second intra-abdominal non-urological malignancy: colonic tumour - 8, rectal tumour - 3, oesophageal tumour - 2 and gastric tumour - 2. Fifteen patients underwent radical nephrectomy and surgical resection of a synchronous benign intra-abdominal pathology: gall bladder - 8, spleen - 3, uterine fibroid - 1, abdominal aortic aneurysm - 1, colonic polyp - 1 and suspected tumour infiltration of colon - 1. There was a higher morbidity (40%) of radical nephrectomy with synchronous resection of an additional intra-abdominal pathology as compared to radical nephrectomy alone group (25%); however it not was statistically significant (P-value 0.275). Conclusion: It is feasible to offer simultaneous resection of synchronous intra-abdominal pathologies with renal cell carcinoma patients undergoing radical nephrectomy, albeit, at a higher morbidity.