Laparoscopic versus Open Nephrectomy in Patients with ADPKD

Approximately 5% to 10% of all cases of kidney failure are related to autosomal dominant polycystic kidney disease (ADPKD). In up to 20% of patients, nephrectomy is performed due to compressive symptoms, renal-related complications, or in preparation for kidney transplantation. Nephrectomy in patients with ADPKD may pose an additional burden due to large kidney size.

MN Thomas, MD, and colleagues at the University of Cologne, University Hospital of Cologne, Cologne, Germany, reported their experience with laparoscopic nephrectomy as an alternative to open nephrectomy in patients with ADPKD. The report was published online in Langenbeck’s Archives of Surgery [doi.org/10.1007/s00423-022-02737-9].

The summary included the first 12 consecutive laparoscopic nephrectomy procedures for ADPKD from August 2020 to August 2021 at the University Hospital of Cologne. The results were compared with the 12 most recent performed open nephrectomy procedures for ADPKD at the same facility from September 2017 to July 2020. The authors collected and analyzed intra- and postoperative parameters. The 36-Item Short-Form Survey (SF36) questionnaire was used to assess health-related quality of life (HRQoL).

The two groups were similar in age, sex, and median preoperative kidney volumes. Compared with the open group, intraoperative estimated blood loss was significantly less in the laparoscopic group (186 ml vs 33 ml), and the postoperative need for blood transfusion was significantly reduced in the laparoscopic group (P=.0462).

Laparoscopic nephrectomy had significantly longer operative time compared with open nephrectomy (158 minutes vs 107 minutes; P=.0079). One postoperative complication (Clavien Dindo ≥3) occurred with the need for revision surgery in both groups. Scores on the SF36 HRQoL questionnaire revealed excellent postoperative quality of life following laparoscopic nephrectomy.

In summary, the authors said, “Laparoscopic nephrectomy in ADPKD patients is a safe and effective operative procedure independent of kidney size with excellent postoperative outcomes and benefits of minimally invasive surgery. Compared with the open procedure, patients profit from significantly less need for transfusion with comparable postoperative complication rates. However significant longer operation times need to be taken in account.”