Thoraco-abdominal approach in tumour nephrectomy.

In order to prevent intraoperative metastasis, venous invasion and infilitration of the regional lymph nodes by renal carcinoma, the thoraco-abdominal surgical approach is recommended. The vascular pedicle can in this way be explored and ligated before manipulation of the tumour. After total nephrectomy en bloc with the fatty capsule and adrenal gland, paracaval, paraaortal and intravasal lymphadenectomy is performed. Tumorous protrusions into the vena cava can mostly be removed at the same time. Inoperability rate could be reduced to 2.1 per cent as opposed to an earlier 11.3 per cent with the lumbar approach. TNM classification followed the recommendations of the UICC and was supplemented with a four-stage system. No improvement over the lumbar approach in respect of survival has been achieved in the first three postoperative years. However, local recurrence is expected to diminish as a result of improved radicality.