Lubennikov AE, Petrovskii NV, Krupinov GE, Shilov EM, Trushkin RN, Kotenko ON, Glybochko PV: Bilateral Nephrectomy in Patients with Autosomal Dominant Polycystic Kidney Disease and End-Stage Chronic Renal Failure. Nephron DOI 10.1159/000513168
Patients with autosomal dominant polycystic kidney disease (ADPKD) and advanced chronic kidney disease are not uncommonly considered as candidates for elective or emergent bilateral nephrectomy (BN) because of unrelenting abdominal discomfort or early satiety form massive kidney enlargement, infected cysts, persisting gross hematuria, suspected renal cell carcinoma, or to provide “more space” for a transplanted kidney. Open (midline laparotomy) or closed (laparoscopic) procedures are used but outcomes have seldom been compared.
Lubennikov and colleagues retrospectively analyzed their single-center experience with both procedures for BN in 108 patients with ADPKD – 36 with a laparoscopic approach and 72 with open midline laparotomy, specifically addressing complications and mortality. About 35% of the cases were elective and 80% were performed because of infected cysts and urinary tract infections.
Postoperative complications were equal with both procedural approaches and postoperative mortality was only observed in the emergent group (usually associated with bowel injury and sepsis. Laparoscopic surgery was the preferred procedure in elective BN. Incidental renal cell carcinoma was found in 6.4% of cases. The duration of surgery was longer with laparoscopic BN due to the time needed to “flip” the patient during the procedure, but these patients rehabilitated sooner and had a shorter hospital stay. C-reactive protein levels above 173 mg/L preoperatively were associated with a higher risk of mortal complications. This descriptive study provides valuable data on the risk of complications among patients with ADPKD undergoing elective or emergent BN. Whether the type of procedure used influences this risk will likely depend on the indications for the procedures and the experience of the surgical team performing them.