Open surgery for renal cell carcinoma

Large renal tumors that grow locally and progressively, e.g. involving neighboring structures or vessels, are reserved for open surgical treatment. All established surgical techniques and access routes are available for these tumors in the Clinical Department of Urology and Urological Oncology.

An individual treatment plan is developed for each patient depending on the size of the tumors to be treated, the neighboring structures involved or the vessels involved. This determines the type of operation and access route. The following operations are generally available

• Open organ-preserving partial kidney resection (partial nephrectomy)
• Open kidney removal (nephrectomy)
• Open kidney removal and vascular reconstruction with vascular involvement

The following access routes are used for surgical access:

• Lumbar approach (flank incision), usually between the 11th and 12th ribs while sparing the abdominal cavity
• Median laparotomy (mid-abdominal incision) for larger tumors and enlarged lymph nodes in the area of the large vessels
• Chevron incision (rib margin incision or extended rib margin incision), e.g. for partial kidney resections for large tumors and imperative (compelling) indications or vascular involvement (cava thrombus)

For tumors with extensive cava thrombi (tumor cones in the great vena cava), a multidisciplinary diagnostic and treatment concept has been developed over many years. Patients with these complex diseases are examined in a standardized manner, prepared for surgery according to an internal guideline and, depending on the extent of the vascular involvement, treated on an interdisciplinary basis together with the Clinical Department of Visceral and Transplant Surgery and the Clinical Department of Urology and Urological Oncology in the Department of Cardiothoracic, Transplant and Vascular Surgery.