The method of extracorporeal resection of the kidney in conditions of pharmaco-cold ischemia in kidney cancer with orthotopic renal replantation

Abstract

BACKGROUND: Increasing the effectiveness of the treatment of patients with kidney cancer is one of the main problems of oncourology. In its solution, great importance is attached to the development of new surgical technologies.

AIM: The aim of the study – to evaluate the results of extracorporeal kidney resection in conditions of pharmaco-cold ischemia with orthotopic renal replantation in kidney cancer patients. Our study is aimed at assessing the results of extracorporeal resection of the kidney under pharmaco-cold ischemia with orthotopic replantation of renal vessels in patients with kidney cancer.

MATERIALS AND METHODS: 44 patients [of them, 70.5% (n = 31) – men and 29.5% (n = 13) – women] with kidney cancer were recruited in a study. All patients were treated between 2012 and 2021. The mean age of patients was 55.92 ± 12.6 years. The stage was determined using the TNM system: pT1a-3bN0M0-1 G1-3. 75% (n = 33) of patients had stage pT1a–1b; 11.4% (n = 5) – pT2a–2b, one patient was present with multiple lesions; 13.6% (n = 6) – pT3a–3b, one patient had up to 15 lesions in a single kidney. Two previously operated patients had cancer of a single kidney with intraluminal invasion. The mean R.E.N.A.L nephrometric score was 10.32 ± 1.34.

RESULTS: The duration of the surgery was 402.07 ± 83.21 minutes. The duration of cold ischemia was 149.9 ± 53.1 minutes. Blood loss – 751.1 ± 633.6 ml. Renal vascular replacement was performed in 13 patients. Postoperative complications >II degree according to Clavien – Dindo were detected in 36.6% (16) of patients. There was only one lethal outcome due to mesenteric thrombosis at day 4. Disease progressed in 6.8% (n = 3) of cases. The GFR level before surgery was on average 72.3 ± 16.8 ml / (min · 1.73 m²⁾, in the early postoperative period – 58.7 ± 28.3 ml / (min · 1.73 m²⁾, 1 year after surgery – 69.4 ± 26.2 ml / (min · 1.73 m²⁾. One year after surgery it was 69.4 ± 26.2 μmol/l. The follow-up period ranged from 8 to 86 months (on average 58.7 ± 19.1 months).

CONCLUSIONS: This technique is effective in patients with multiple foci, centrally located and large tumors, for hard-to-reach localizations, as well as in patients with the impossibility of intracorporeal pharmaco-cold ischemia, peculiarities of organ blood supply.

Keywords

renal cell carcinoma / cold ischemia / kidney resection / nephrectomy

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