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

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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.

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About the authors

Irina V. Miroshkina

A.V. Vishnevsky National Medical Research Center of Surgery

Email: homa0308@gmail.com
ORCID iD: 0000-0002-3208-198X
SPIN-code: 8036-4759
Scopus Author ID: 57194755893

Junior Researcher

Russian Federation, Moscow

Tatyana P. Baytman

A.V. Vishnevsky National Medical Research Center of Surgery

Email: bit.t@mail.ru
ORCID iD: 0000-0002-3646-1664
SPIN-code: 4684-3230
Scopus Author ID: 57219438104

Postgraduate student

Russian Federation, Moscow

Zholboldu Polotbek uulu

A.V. Vishnevsky National Medical Research Center of Surgery

Email: jolboldu94.01@gmail.com
ORCID iD: 0000-0002-2424-0493

Junior Researcher

Russian Federation, Moscow

Vardan A. Oganyan

A.V. Vishnevsky National Medical Research Center of Surgery

Email: vardan_94@mail.ru
ORCID iD: 0000-0002-2059-8703

Junior Researcher

Russian Federation, Moscow

Alina A. Chevina

A.V. Vishnevsky National Medical Research Center of Surgery

Email: a.chevina@mail.ru
ORCID iD: 0000-0001-8066-2626

anesthesiologist-resuscitator

Russian Federation, Moscow

Vlada Yu. Raguzina

A.V. Vishnevsky National Medical Research Center of Surgery

Email: vlada94@bk.ru
ORCID iD: 0000-0002-1527-670X
SPIN-code: 8150-7336
Scopus Author ID: 57223053364

Junior Researcher

Russian Federation, Moscow

Anton D. Simonov

A.V. Vishnevsky National Medical Research Center of Surgery

Email: simonov.anton.md@gmail.com
ORCID iD: 0000-0003-3202-6873

clinical resident

Russian Federation, Moscow

Alexey V. Chzhao

A.V. Vishnevsky National Medical Research Center of Surgery

Email: chzhao@ixv.ru
ORCID iD: 0000-0002-0204-8337
SPIN-code: 1101-6874

Doc. Sci. (Med.), Professor, Head of the Oncology Department

Russian Federation, Moscow

Alexander A. Pranovich

A.V. Vishnevsky National Medical Research Center of Surgery

Author for correspondence.
Email: pranovich@ixv.ru
ORCID iD: 0000-0002-6034-9269
SPIN-code: 1096-6331

Cand. Sci. (Med.), Senior Researcher

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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1. Fig. 1. The mobilized kidney on the crossed vessels in a tray with ice crumbs

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2. Fig. 2. Resection of a tumor within healthy tissues. 1 – wound surface of the kidney; 2 – conglomerate multiple tumor

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3. Fig. 3. Reconstruction of the collecting system of the kidney

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4. Fig. 4. Reimplanted kidney. 1 – venovenous anastomosis between the renal vein stump and the inferior vena cava; 2 – vascular anastomosis between the renal artery stump and the aorta

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5. Fig. 5. Distribution of postoperative complications according to the severity according to the Clavien – Dindo classification

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