Laparoscopic nephrectomy for polycystic kidney disease: Benefit or necessity?

Background. According to foreign and domestic authors, autosomal dominant polycystic kidney disease (ADPKD) is a disease accompanied by a progressive deterioration in the functional state of the kidneys and occupies a significant contribution to the structure of all causes leading to the end stage of chronic renal failure (ESRD). An increase in the volume of the kidneys and the development of complications significantly worsen the quality of life of these patients. Open surgical interventions are accompanied by a more severe course. In this connection, the question of choosing the timing and method of surgical intervention in this group of patients remains relevant.

Aim. To evaluate the results of nephrectomy in patients with ADPKD for the period from 2016 to 2022, performed at the Krasnoyarsk Regional Clinical Hospital.

Materials and methods. Within 6 years, 22 nephrectomies were performed in 20 patients with ADPKD. Monolateral nephrectomy was performed in 12 cases, simultaneous bilateral surgery was performed in eight patients. The mean age of the patients was 51.3±7.9 years. Mostly nephrectomy was performed by laparoscopic approach (17 patients), lumbotomy operation was performed in three patients. The need for conversion during laparoscopic operations was not noted.

Results. Open surgical treatment was performed only because of uncontrolled gross hematuria and suppuration of cysts. All patients were transferred to the intensive care unit after surgery. Repeated surgery due to the development of bleeding was required in 33.3% of cases. The need for an inpatient stage of treatment was 15.1±2.8 days. In one case, a fatal outcome was recorded. Laparoscopic nephrectomy was performed in 17 patients, monolateral in seven patients, staged bilateral in two, and simultaneous bilateral in eight patients. In 41% of cases, in addition to pain and hypertension, nephrectomy was due to the upcoming kidney transplantation. The average volume of removed kidneys was 3138.74±356.30 ml. The average bed-day was 8.86±2.4 days.

Conclusion. The increase in the number of patients with ADPKD and ESRD raises the question of the improvement in their quality of life that can be achieved by unilateral or bilateral nephrectomy. However, there are no clearly regulated criteria that determine the indications for these types of surgery. Despite certain difficulties, we believe that laparoscopic nephrectomy in patients with ADPKD and ESRD is the most optimal.