Оrgan-preserving surgery of renal cancer


Keywords: renal resection; resection of a single kidney; renal cancer; thermal ischemia; renal decapsulation; оrgan-preserving surgery; laparoscopy; laparoscopic renal resection

Abstract

Objective. To present own experience in a light of generally accepted tendencies in organ-preserving surgery of renal cancer.

Маterials and methods. From 2008 tо Dec. 2017 yr there were performed 127 renal resections, of them 32 - laparoscopically, in 111 observations - for renal cancer.

Results. In open renal resection in 74% of observations the thermal ischemia was applied during 10 - 27 min, 14 min at average. During laparoscopic renal resection the thermal ischemia was used in 82% of observations, its duration have constituted 9 - 39 min, 26 min at average. Average duration of operation in laparoscopic renal resection have constituted (170 ± 40) min, while the open access one - (104 ± 40) min. After both types of operations a histologically negative edge of resection was confirmed. During period of observation a recurrence of a renal-cellular cancer was revealed in 3 (2.4%) patients after open renal resection on Stage T3a (histologically - tumoral emboli in segmental vessels). Laparoscopic nephrectomy was done in all of these patients. A disease-free survival have constituted 97.6%.

Conclusion. Performance of laparoscopic renal resection is secure in patients with tumor in Stage рТ1 and is not connected with big quantity of perioperative complications, comparing with open renal resection, but in this situation a duration of  renal thermal ischemia enhances trustworthily. For strictly selected patients among operative accesses it is mandatory to choose those, which may be conducted without renal thermal ischemia.

References

1. Raz O, Mendlovic S, Shilo Y, Leibovici D, Sandbank J, Lindner A, et al. Positive surgical margins with renal cell carcinoma have a limited influence on long-term oncological outcomes of nephron sparing surgery. Urology. 2010 Feb;75(2):277-80. doi: 10.1016/j.urology.2009.06.110.

2. Marszalek M, Meixl H, Polajnar M, Rauchenwald M, Jeschke K, Madersbacher S. Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur Urol. 2009 May;55(5):1171-8. doi: 10.1016/j.eururo.2009.01.042.

3. Peycelon M, Hupertan V, Comperat E, Renard-Penna R, Vaessen C, Conort P, et al. Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol. 2009 Jan;181(1):35-41. doi: 10.1016/j.juro.2008.09.025.

4. Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR Jr, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007 Jul;178(1):41-6.

5. Delakas D, Karyotis I, Daskalopoulos G, Terhorst B, Lymberopoulos S, Cranidis A. Nephron-sparing surgery for localized renal cell carcinoma with a normal contralateral kidney: a European three-center experience. Urology. 2002 Dec;60(6):998-1002. PMID: 12475657.

6. Thompson RH, Boorjian SA, Lohse CM, Leibovich BC, Kwon ED, Cheville JC, et al. Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol. 2008 Feb;179(2):468-71; discussion 472-3. doi: 10.1016/j.juro.2007.09.077.

7. Kogan MI, Gusev AA, Evseev SV. Ocenka pochechnoj funkcii u bol'nyh pochechno-kletochnym rakom do i posle radikal'noj nefrjektomii. Onkourologija. 2011;(4):20-4. [In Russian].

8. Kogan MI, Gusev AA, Evseev SV. Ocenka pochechnyh funkcij i operativnoe lechenie pochechno-kletochnogo raka. Onkourologija. 2013;(1):17-23. [In Russian].

9. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004 Sep 23;351(13):1296-305. doi: 10.1056/NEJMoa041031.

10. Stepushkin SP, Chajkovskij VP, Sokolenko RV, Alifanov ID, Tereshhenko PV, Novikov SP, Sergeev VN. Jevoljucija tehniki rezekcii pochki. Ukraїns'kij zhurnal maloіnvazivnoї ta endoskopichnoї hіrurgії. 2014;18(1):23-8. [In Russian].

11. Gettman MT, Blute ML, Chow GK, Neururer R, Bartsch G, Peschel R. Robotic-assisted laparoscopic partial nephrectomy: technique and initial clinical experience with DaVinci robotic system. Urology. 2004 Nov;64(5):914-8. doi: 10.1016/j.urology.2004.06.049.

12. Rassweiler JJ, Abbou C, Janetschek G, Jeschke K. Laparoscopic partial nephrectomy. The European experience. Urol Clin North Am. 2000 Nov;27(4):721-36. PMID: 11098770.

13. Teodorovich OV, Galljamov JeA, Jankovskaja IE, et al. Laparo- i retroperitoneoskopicheskaja rezekcija pochki. Urologija. 2011;(3):43-7. [In Russian].

14. Porpiglia F, Mari A, Bertolo R, Antonelli A, Bianchi G, Fidanza F. Partial nephrectomy in clinical T1b renal tumors: multicenter comparative study of open, laparoscopic and robot-assisted approach (the RECORd Project). Urology. 2016 Mar;89:45-51. doi: 10.1016/j.urology.2015.08.049.

15. Zhao PT, Richstone L, Kavoussi LR. Laparoscopic partial nephrectomy. Int J Surg. 2016 Dec;36(Pt C):548-553. doi: 10.1016/j.ijsu.2016.04.028.

Author Biographies


S. P. Styopushkin, Dnepropetrovsk Municipal Multidisciplinary Clinical Hospital № 4, Сity of Dnepr

Styopushkin Sergiy P. - MD, PhD (Med).

Head of Department of Urology #1,

Dnipropetrovsk City Multifield Clinical Hospital #4 “DRU”

31, Blyzhnya Street, 49102, Dnipro, Ukraine

+380562583291

step74@ukr.net

https://orcid.org/0000-0001-7841-2484


V. P. Chaikovskyi, Dnepropetrovsk Municipal Multidisciplinary Clinical Hospital № 4, Сity of Dnepr

Chaikovskyi Viktor P. - MD.

Physician in Department of Urology #1,

Dnipropetrovsk City Multifield Clinical Hospital #4 “DRU”

31, Blyzhnya Street, 49102, Dnipro, Ukraine

+380562583291

witamin@ukr.net

https://orcid.org/0000-0001-7974-3656


R. V. Sokolenko, Dnepropetrovsk Municipal Multidisciplinary Clinical Hospital № 4, Сity of Dnepr

Sokolenko Ruslan V. - MD.

Physician in Department of Urology #1,

Dnipropetrovsk City Multifield Clinical Hospital #4 “DRU”

31, Blyzhnya Street, 49102, Dnipro, Ukraine

+380562583291

uroson@ukr.net

https://orcid.org/0000-0002-9083-4177


V. A. Chernilovskyi, Dnepropetrovsk Municipal Multidisciplinary Clinical Hospital № 4, Сity of Dnepr

Chernylovskyi Volodymyr A. - MD.

Physician in Department of Urology #1,

Dnipropetrovsk City Multifield Clinical Hospital #4 “DRU”

31, Blyzhnya Street, 49102, Dnipro, Ukraine

+380562583291

chernylovskyi@gmail.com

https://orcid.org/0000-0002-5795-1574

Published
2018-10-29
How to Cite
Styopushkin, S. P., Chaikovskyi, V. P., Sokolenko, R. V., & Chernilovskyi, V. A. (2018). Оrgan-preserving surgery of renal cancer. Klinicheskaia Khirurgiia, 85(10), 66-70. https://doi.org/10.26779/2522-1396.2018.10.66
Section
General Problems of Surgery