The method of extracorporeal resection of the kidney in conditions of pharmaco-cold ischemia in kidney cancer with orthotopic renal replantation
- Authors: Miroshkina I.V.1, Baytman T.P.1, Polotbek uulu Z.1, Oganyan V.A.1, Chevina A.A.1, Raguzina V.Y.1, Simonov A.D.1, Chzhao A.V.1, Pranovich A.A.1
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Affiliations:
- A.V. Vishnevsky National Medical Research Center of Surgery
- Issue: Vol 11, No 4 (2021)
- Pages: 275-284
- Section: Original articles
- URL: https://journals.eco-vector.com/uroved/article/view/83884
- DOI: https://doi.org/10.17816/uroved83884
- ID: 83884
Cite item
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
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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, MoscowTatyana 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, MoscowZholboldu 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, MoscowVardan 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, MoscowAlina 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, MoscowVlada 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, MoscowAnton 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, MoscowAlexey 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, MoscowAlexander 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, MoscowReferences
- Ljungberg B, Campbell SC, Choi HY, et al. The epidemiology of renal cell carcinoma. Eur Urol. 2011;60:615–621. doi: 10.1016/j.eururo.2011.09.001
- Kaprin AD, Starinskiy VV, Petrova GV, editors. Zlokachestvennye novoobrazovanija v Rossii v 2017 godu (zabolevaemost’ i smertnost’). Moscow; 2018. 250 p. (In Russ.)
- Gill IS, Kavoussi LR, Lane BR, Blute ML, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. Journal of Urology. 2007;178(1):41–46. doi: 10.1016/j.juro.2007.03.038
- Simhan J, Smaldone MC, Tsai KJ, et al. Objective measures of renal mass anatomic complexity predict rates of major complications following partial nephrectomy. Eur Urol. 2011;60(4):724–730. doi: 10.1016/j.eururo.2011.05.030
- Ljungberg B, Bensalah K, Canfield S, et al. EAU guidelines on renal cell carcinoma: the 2014 update. European Urology. 2015;67(5):913–924. doi: 10.1016/j.eururo.2015.01.005
- Crispen PL, Greenberg RE, Chen DYT, Uzzo RG. Аctive surveillance of enhancing renal tumors. Oncourology. 2007;(4):17–21.
- Komyakov BK, Zamyatnin SA, Novikov AI, et al. Extracorporeal partial nephrectomy for neoplasm. Urologiia. 2013;(4):60–63. (In Russ.)
- Zotikov AE, Adyrkhaev ZA, Teplov AA, et al. Use of an ex vivo technique in a patient with renal arteriovenous malformation in complication endovascular treatment. Angiology and Vascular Surgery. 2017;23(2):118–125. (In Russ.)
- Gritskevich AA, Miroshkina IV, Piyanikin SS, et al. Extracorporeal partial nephrectomy under pharmaco-cold ischemia for renal cell carcinoma. Pirogov Russian Journal of Surgery. 2017;(1):42–47. doi: 10.17116/hirurgia2017142-47 (In Russ.)
- Kulisa M, Bensouda A, Vaziri N, et al. Complex renal tumors on solitary kidney: results of ex vivo nephron-sparing surgery with autotransplantation. Prog Urol. 2010;20(3)194–203. doi: 10.1016/j.purol.2009.10.019
- Gritskevich AA, Miroshkina IV, Baitman TP, et al. Extracorporeal partial nephrectomy during pharmaco-cold ischemia in patients with renal cell carcinoma: history and current problems. Experimental and Clinical Urology. 2019;(4):32–39. doi: 10.29188/2222-8543-2019-11-4-32-39 (In Russ.)
- Matveev VB, Perlin DV, Figurin KM, Volkova MI. Organosohranjajushhee lechenie raka pochki. Prakticheskaja onkologija. 2005;6(3):162–166. (In Russ.)
- Gritskevich AA, Pyanikin SS, Makrushin MS, et al. Extracorporeal resection of solitary kidney with trombectomy from the vena cava inferior with orthotopic replantation of the vessels in patient with renal cancer. Experimental and Clinical Urology. 2015;(3):132–137. (In Russ.)
- . Gritskevich AA, P’yanikin SS, Adyrkhaev ZA, et al. Ex vivo kidney resection in pharmacological cold ischemia followed by orthotopic autotransplantation. Transplantologiya. 2016;(3):27–36. (In Russ.)
- Association of urology. TNM classification tumor of kidney. Guidelines. EAU; 2017;14–15.
- Miroshkina IV, Grickevich AA, Baytman TP, et al. The role of markers of acute kidney damage in assessing kidney function with its ischemia. Experimental and Clinical Urology. 2018;(4):114–121. (In Russ.)
- Kim SP, Thompson RH, Boorjian SA, Weight CJ, et al. Comparative effectiveness for survival and renal function of partial and radical nephrectomy for localized renal tumors: a systematic review and meta-analysis. J Urol. 2012;188(1):51–57. doi: 10.1016/j.juro.2012.03.006
- Teplov AA, Gritskevich AA, Pyanikin SS, et al. Extracorporeal resection of the kidney in the setting of the pharmacological and cold temperature ischemia with orthotopic replantation of the vessels without ureter transaction in patients with renal cell carcinoma. Experimental and Clinical Urology. 2015;(2):52–63. (In Russ.)
- Shuch B, Hanley J, Lai J, et al. Overall survival advantage with partial nephrectomy: a bias of observational data? Cancer. 2013;119(16):2981–2989. doi: 10.1002/cncr.28141
- Tobert CM, Riedinger CB, Lane BR. Do we know (or just believe) that partial nephrectomy leads to better survival than radical nephrectomy for renal cancer? World J Urol. 2014;32(3):573–579. doi: 10.1007/s00345-014-1275-8
- Arnold ML, Thiel DD, Diehl N, et al. Comparison of baseline quality of life measures between renal cell carcinoma patients undergoing partial versus radical nephrectomy. BMC Urology. 2013;13:52. doi: 10.1186/1471-2490-13-52
- Kaushik D, Kim SP, Childs MA, et al. Overall survival and development of stage IV chronic kidney disease in patients undergoing partial and radical nephrectomy for benign renal tumors. European Urology. 2013;64(4):600–606. doi: 10.1016/j.eururo.2012.12.023
- Mano R, Kent M, Larish Y, et al. Partial and Radical Nephrectomy for Unilateral Synchronous Multifocal Renal Cortical Tumors. Urology. 2015;85(6):1404–1410. doi: 10.1016/j.urology.2015.02.032
- Yasuda Y, Yuasa T, Yamamoto S, et al. Evaluation of the RENAL nephrometry scoring system in adopting nephron-sparing surgery for cT1 renal cancer. Urol Int. 2013;90(2):179–183. doi: 10.1159/000342971
- An JY, Ball MW, Gorin MA, Hong JJ. Partial vs Radical Nephrectomy for T1-T2 Renal Masses in the Elderly: Comparison of Complications, Renal Function, and Oncologic Outcomes. Urology. 2017;100:151–157. doi: 10.1016/j.urology.2016.10.047
- Kunath F, Schmidt St, Krabbe LM, et al. Partial nephrectomy versus radical nephrectomy for clinical localised renal masses. Cochrane Database Syst Rev. 2017;5(5): CD012045. doi: 10.1002/14651858.CD012045
- Streja E, Kalantar-Zadeh K, Molnar MZ, et al. Radical versus partial nephrectomy, chronic kidney disease progression and mortality in US veterans. Nephrol Dial Transplant. 2018;33(1):95–101. doi: 10.1093/ndt/gfw358
- Van Poppel H, Da Pozzo L, Albrecht W, et al. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol. 2011;59(4):543–552. doi: 10.1016/j.eururo.2010.12.013
- Zini L, Perrotte P, Capitanio U, et al. Radical versus partial nephrectomy: effect on overall and noncancer mortality. Cancer. 2009;115(7):1465–1471. doi: 10.1002/cncr.24035
- Tan HJ, Norton EC, Ye Z, et al. Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer. JAMA. 2012;307(15):1629–1635. doi: 10.1001/jama.2012.475
- Patel HD, Kates M, Pierorazio PM, et al. Balancing cardiovascular (CV) and cancer death among patients with small renal masses: modification by CV risk. BJU Int. 2014;115(1):58–64. doi: 10.1111/bju.12719
- Shuch B, Hanley J, Lai J, et al. Overall survival advantage with partial nephrectomy: a bias of observational data? Cancer. 2013;119(16):2981–2989. doi: 10.1002/cncr.28141
- Kates M, Badalato GM, Pitman M, et al. Increased risk of overall and cardiovascular mortality after radical nephrectomy for renal cell carcinoma 2 cm or less. J Urol. 2011;186(4):1247–1253. doi: 10.1016/j.juro.2011.05.054
- Huang WC, Elkin EB, Levey AS, et al. Partial nephrectomy versus radical nephrectomy in patients with small renal tumors – is there a difference in mortality and cardiovascular outcomes? J Urol. 2009;181(1):55–61. doi: 10.1016/j.juro.2008.09.017