Midline Incision versus Chevron Incision in Open Radical Nephrectomy: Quality of Life Differences

Abstract

Objective: Open radical nephrectomy can be performed through midline or chevron incision. This study aims to compare the quality of life between midline and chevron incision in open radical the nephrectomy since comparison studies between these approach focused on quality life are still lacking.

Methods: This study includes total 31 patients that underwent open radical nephrectomy in Cipto Mangunkusumo Hospital Indonesia. The subjects were divided into midline and chevron groups using simple random sampling. Modified WHOQOL BREF and VAS pain score were compared between these groups.

Results: Total 31 subjects included, with a male: female ratio 2.33:1 and age mean 49.81±13.1 with the incidence are highest at 41-60 years old. In our study, most subjects were diagnosed in T3-T4 with 58,07% overall. Clear cell renal cell carcinoma is the most frequent pathology result with 41,93% followed by Paper Renal cell Carcinoma 12.90%. VAS score is higher in Chevron group with result 2,47±1,40 compare to Midline group with 2,13±1,99. Match to the VAS score result, The Modified WHOQOL BREF Chevron group with mean 71,80±10,24 is lower than Midline group with 77,69±13,65. However, these differences are not statistically significant. The midline group was recorded two complications (IVC and spleen injury), whereas one complication (IVC injury) recorded in chevron group.

Conclusion: Both chevron and the midline are safe methods for open nephrectomy. Even the midline incision show better VAS score and quality of life, and there are no significant differences between midline or chevron incision in postoperative quality of life, VAS scores and intraoperative bleeding.