Possibilities and features of zero-ischemia nephron-sparing surgery in localized kidney cancer

Kidney cancer (KCa) is one of the greatest challenges in oncological urology due to the increase in morbidity and mortality rates annually. In the treatment of KCa, preservation of renal function is an important objective, in addition to achieving oncological results. The article presents the experience of treatment of 175 KCa-patients of pT1a – T2aN0M0 stages, who underwent nephron-saving surgery (NSS) with preventive hemostatic sutures. Functional outcomes of NSS were studied in the groups without cross-linking (group 1; n = 150) and with cross-linking of the renal pedicle (group 2; n = 25). Kidney resection with prophylactic suturing has been shown to allow removal of a tumour of almost any localisation. By avoiding cross-linking of the renal pedicle during surgery, post-ischemic changes in the renal parenchyma are minimised. Thus, one month after surgery, the perfusion indexes in groups 1 & 2 were 45.2 ± 3.0% vs 35.5 ± 3.3%; renal indexes were 44.8 ± 2.4% vs 39.1 ± 1.4%; areas of the functioning parenchyma were 52.0 ± 10.0% vs 35.0 ± 9.0%, respectively

Превентивный гемостатический шов при открытой резекции почки как один из способов сохранения почечной функции

Introduction. Renal cancer is one of the leading urological cancers due to annually increasing morbidity and mortality rates.Objective: to prove the efficiency of preventive hemostatic sutures during partial nephrectomy for maximal preservation of functional renal parenchyma in patients with renal cell carcinoma.Materials and methods. We developed and implemented a new technique of partial nephrectomy with preventive hemostatic suture, that allows not to clamp the renal pedicle, even in case of central tumor location. Main benefit of this technique is minimization of kidney function loss after the operation, which is the major aim of nephron sparing surgery. Study included 150 patients with pT1a–pT2bN0M0 kidney cancers. Central tumor location was in 64 patients, 45 patients had upper segment tumors and 41 lower segment tumors. 74 patients had T1a tumor stage, T1b and T2a stage observed in 53 and 4 patients respectively. Nineteen patients were diagnosed with cystic carcinoma. To evaluate renal function, dynamic nephroscintigraphy was carried out and volume indices were calculated by computed tomography data.Results. All patients underwent nephron sparing surgery using preventive hemostatic sutures. Mean operative time was 180 ± 40 minutes, mean anesthesia time was 190.5 ± 15.0 minutes. Mean blood loss was 250 ± 70 ml. We didn’t used arteria clamping and warm ischemia and there was no conversions to nephrectomy during all partial nephrectomies. Perfusion index of the kidney before the surgery was 54.13 ± 2.00 %, after the surgery 46.23 ± 3.00 %, renal index was 53.24 ± 4.00 % and 46.82 ± 2.39 %, respectfully. In our opinion decreasing of renal indexes in early postoperative period is associated with loss of kidney parenchyma due to the surgery. Mean kidney volume was 140 ± 30 cm3 with 120 ± 20 см3 functional parenchyma volume and mean tumor volume 40 ± 20 сm3. Functional parenchyma volume after surgery insignificantly decreased to 115 ± 20 сm3.Conclusion. Preventive hemostatic sutures during partial nephrectomy allows to remove the tumor in almost any part of the kidney. Rejection of renal hilum clamping minimizes ischemical damages of renal parenchyma. Введение. Рак почки является одной из наиболее важных проблем онкоурологии в связи с ежегодно возрастающей заболеваемостью и смертностью от данного новообразования.Цель исследования – доказательство эффективности резекции почки с превентивным гемостатическим швом для максимального сохранения функционирующего объема почечной ткани у пациентов с почечно-клеточным раком.Материалы и методы. В урологической клинике ГКБ им. С. П. Боткина разработана и внедрена методика выполнения резекции почки с применением превентивных гемостатических швов. Она позволяет проводить операции без пережатия почечной ножки, в том числе при центрально расположенных опухолях. В исследование были включены 150 больных раком почки стадий pT1a–Т2bN0M0. У 64 пациентов опухоль располагалась в центральном сегменте, у 45 – в верхнем и у 41 – в нижнем. Стадия T1a была установлена у 74 больных, стадия T1b – у 53, стадия T2a – у 4. У 19 пациентов диагностирована кистозная форма рака. В целях оценки почечной функции проводили динамическую нефросцинтиграфию, а также расчет объемных показателей по данным компьютерной томографии.Результаты. Всем пациентам выполнены органосохраняющие операции. Продолжительность хирургического вмешательства составила 180 ± 40 мин, среднее время общей анестезии – 190,5 ± 15,0 мин. Объем средней кровопотери составил 250 ± 70 мл. Ни в одном из случаев почечную ножку не пережимали. Также не было конверсии в нефрэктомию. Перфузионный индекс для оперированной почки до вмешательства составил 54,13 ± 2,00 %, после – 46,23 ± 3,00 %, ренальный индекс до операции – 53,24 ± 4,00 %, после – 46,82 ± 2,39 %. Полагаем, что некоторое снижение значений указанных показателей в раннем послеоперационном периоде связано с уменьшением объема почечной паренхимы. Средний объем почки, пораженной опухолью, был 140 ± 30 см3, из них объем функционирующей паренхимы составил в среднем 120 ± 20 см3, объем опухолевого поражения – 40 ± 20 см3. После операции объем функционирующей паренхимы составил 115 ± 20 см3.Заключение. Таким образом, резекция почки с превентивным швом позволяет удалять опухоль из практически любого отдела почки. Отсутствие пережатия почечной ножки в ходе операции позволяет свести к минимуму постишемические изменения в почечной паренхиме

Preventive hemostatic suture during open kidney resection as an option to preserve the renal function

Introduction. Renal cancer is one of the leading urological cancers due to annually increasing morbidity and mortality rates.Objective: to prove the efficiency of preventive hemostatic sutures during partial nephrectomy for maximal preservation of functional renal parenchyma in patients with renal cell carcinoma.Materials and methods. We developed and implemented a new technique of partial nephrectomy with preventive hemostatic suture, that allows not to clamp the renal pedicle, even in case of central tumor location. Main benefit of this technique is minimization of kidney function loss after the operation, which is the major aim of nephron sparing surgery. Study included 150 patients with pT1a–pT2bN0M0 kidney cancers. Central tumor location was in 64 patients, 45 patients had upper segment tumors and 41 lower segment tumors. 74 patients had T1a tumor stage, T1b and T2a stage observed in 53 and 4 patients respectively. Nineteen patients were diagnosed with cystic carcinoma. To evaluate renal function, dynamic nephroscintigraphy was carried out and volume indices were calculated by computed tomography data.Results. All patients underwent nephron sparing surgery using preventive hemostatic sutures. Mean operative time was 180 ± 40 minutes, mean anesthesia time was 190.5 ± 15.0 minutes. Mean blood loss was 250 ± 70 ml. We didn’t used arteria clamping and warm ischemia and there was no conversions to nephrectomy during all partial nephrectomies. Perfusion index of the kidney before the surgery was 54.13 ± 2.00 %, after the surgery 46.23 ± 3.00 %, renal index was 53.24 ± 4.00 % and 46.82 ± 2.39 %, respectfully. In our opinion decreasing of renal indexes in early postoperative period is associated with loss of kidney parenchyma due to the surgery. Mean kidney volume was 140 ± 30 cm3 with 120 ± 20 см3 functional parenchyma volume and mean tumor volume 40 ± 20 сm3. Functional parenchyma volume after surgery insignificantly decreased to 115 ± 20 сm3.Conclusion. Preventive hemostatic sutures during partial nephrectomy allows to remove the tumor in almost any part of the kidney. Rejection of renal hilum clamping minimizes ischemical damages of renal parenchyma