Five year review of open radical nephrectomies at a regional hospital in South Africa: room for improvement

Keywords: Renal cell carcinoma, nephrectomy, open nephrectomy, radical nephrectomy, transfusion rate, complications, South Africa

Abstract

Background: To review the presentation and outcomes of patients undergoing open radical nephrectomy (ORN) for renal cell carcinoma (RCC) at a regional hospital in KwaZulu-Natal, South Africa.

Methods: A retrospective chart review was performed of patients having undergone nephrectomy at St Aidan’s hospital between 2010 and 2015, focusing on those with RCC. Demographic, operative, histopathology and outcomes data were collected.

Results: Fifty-two patients (51%) had ORN for suspected malignant disease. Forty-one RCCs were found including one incidental finding at simple nephrectomy. Data was insufficient to assess risk factors for RCC. HIV positive patients tended to present earlier (45 vs. 53 years). The mean tumour size was 10 cm and organ confined disease was present in 73.2% of patients. Only 11 patients (26.8%) had pT1 disease. The high-grade complication rate was 9.8%, in-hospital mortality rate 4.9% and transfusion rate 51.2%. The median operating time was 1h 50min and length of hospital stay 13 days.

Conclusions: Open radical nephrectomy is the standard surgical treatment for RCC at regional level in South Africa. Patients tend to present at a younger age, particularly if HIV positive, and with large tumours. Further research into risk factors for RCC in the South African population is needed. There are high complication and transfusion rates in patients undergoing ORN. Review of accessibility of blood at St Aidan’s hospital and revision of the transfusion protocol is suggested. A follow-up study to assess the feasibility and cost-effectiveness of laparoscopic nephrectomy in the resource-constrained South African environment is necessary.

Author Biographies

Avikar Singh, Greys Hospital and University of KwaZulu-Natal

Department of Urology
Greys Hospital; and
Nelson R Mandela School of Medicine
University of KwaZulu-Natal

Ronald James Urry, Greys Hospital and University of KwaZulu-Natal
Department of Urology
Greys Hospital; and
Nelson R Mandela School of Medicine
University of KwaZulu-Natal
Timothy Craig Hardcastle, University of KwaZulu-Natal

Nelson R Mandela School of Medicine
University of KwaZulu-Natal; and
Trauma Surgery Training Unit
Department of Surgery
University of KwaZulu-Natal; and
Trauma Service
Inkosi Albert Luthuli Central Hospital

Published
2018-04-10
How to Cite
Singh, A., Urry, R., & Hardcastle, T. (2018). Five year review of open radical nephrectomies at a regional hospital in South Africa: room for improvement. South African Journal of Surgery, 56(1), 35-39. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/2195
Section
Urology