Possibilities and features of zero-ischemia nephron-sparing surgery in localized kidney cancer
A. V. Seregin,
O. B. Loran,
A. A. Seregin,
N. A. Shustitskiy,
I. V. Seregin,
O. V. Bessolova,
T. R. Indarokov https://doi.org/10.21886/2308-6424-2023-11-2-188-202
Abstract
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.
Supporting agencies: The study was not sponsored
About the Authors
A. V. Seregin
Russian Medical Academy of Continuing Professional Education; Botkin City Clinical Hospital
Russian Federation
Competing Interests:
Russian Federation
Alexandr V. Seregin — M.D., Dr. Sc.(Med), Full Prof., Hons. Phys. of the Russian Federation; Prof., Dept. of Urology and Surgical Andrology, Russian Medical Academy of Continuous Professional Education; Head, Urology Division No. 41, Botkin City Clinical Hospital.
Moscow
Competing Interests:
The authors declare no conflict of interest
O. B. Loran
Russian Medical Academy of Continuing Professional Education
Russian Federation
Competing Interests:
Russian Federation
Oleg B. Loran — M.D., Dr. Sc.(Med), Full Prof., Academ. of the RAS, Hons. Sci. of the Russian Federation; Head, Dept. of Urology and Surgical Andrology.
Moscow
Competing Interests:
The authors declare no conflict of interest
A. A. Seregin
Russian Medical Academy of Continuing Professional Education; Botkin City Clinical Hospital
Russian Federation
Competing Interests:
Russian Federation
Александр Александрович Серегин — кандидат медицинских наук; доцент кафедры урологии и хирургической андрологии ФГБОУ ДПО РМАНПО Минздрава России; врач-уролог урологического отделения № 41 ГБУЗ ГКБ им. С.П. Боткина ДЗМ.
Москва
Competing Interests:
The authors declare no conflict of interest
N. A. Shustitskiy
Botkin City Clinical Hospital
Russian Federation
Competing Interests:
Russian Federation
Nikolay A. Shustitskiy — M.D., Сand.Sc. (Med); Urologist, Urology Division No. 41, Botkin City Clinical Hospital
Moscow
Competing Interests:
The authors declare no conflict of interest
I. V. Seregin
Russian Medical Academy of Continuing Professional Education; Botkin City Clinical Hospital
Russian Federation
Competing Interests:
Russian Federation
Medical Academy of Continuous Professional Education; Urologist, Urology Division No. 41, Botkin City Clinical Hospital.
Moscow
Competing Interests:
The authors declare no conflict of interest
O. V. Bessolova
Russian Medical Academy of Continuing Professional Education
Russian Federation
Competing Interests:
Russian Federation
Oksana V. Bessolova — M.D., Сand.Sc. (Med); Head, Radioisotope Diagnostic Division, Russian Medical Academy of Continuous Professional Education.
Moscow
Competing Interests:
The authors declare no conflict of interest
T. R. Indarokov
Russian Medical Academy of Continuing Professional Education
Russian Federation
Competing Interests:
Russian Federation
Tembulat R. Indarokov — Dept. of Urology and Surgical Andrology, Russian Medical Academy of Continuous Professional Education.
Moscow
Competing Interests:
The authors declare no conflict of interest
References
1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69-90. Erratum in: CA Cancer J Clin. 2011;61(2):134. DOI: 10.3322/caac.20107
2. Aliaev Y., Akhvlediani N., Fiev D., Petrovskiy N. Possibilities of visualization methods in diagnostics and monitoring of kidney tumors. Experimental & clinical urology. 2011;(2–3):96-97. (In Russian). eLIBRARY ID: 17328514; EDN: OPFEZB
3. Gill IS, Kavoussi LR, Lane BR, Blute ML, Babineau D, Colombo JR Jr, Frank I, Permpongkosol S, Weight CJ, Kaouk JH, Kattan MW, Novick AC. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007;178(1):41-6. DOI: 10.1016/j.juro.2007.03.038
4. Ivanov A.P., Chernyshev I.V., Tyuzikov I.A. Optimization of spiral computed tomography protocol in the diagnosis of renal tumors. Cancer Urology. 2011;7(2):18-21. (In Russian). DOI: 10.17650/1726-9776-2011-7-2-18-21
5. Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Colombel M, Klotz L, Skinner E, Keane T, Marreaud S, Collette S, Sylvester R. 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):543-52. DOI: 10.1016/j.eururo.2010.12.013
6. Kunath F, Schmidt S, Krabbe LM, Miernik A, Dahm P, Cleves A, Walther M, Kroeger N. Partial nephrectomy versus radical nephrectomy for clinical localised renal masses. Cochrane Database Syst Rev. 2017;5(5):CD012045. DOI: 10.1002/14651858.CD012045.pub2
7. Forbes CM, Rendon RA, Finelli A, Kapoor A, Moore RB, Breau RH, Lacombe L, Kawakami J, Drachenberg DE, Pautler SE, Jewett MMA, Saarela O, Liu Z, Tanguay S, Black PC. Disease progression and kidney function after partial vs. radical nephrectomy for T1 renal cancer. Urol Oncol. 2016;34(11):486.e17-486.e23. DOI: 10.1016/j.urolonc.2016.05.034
8. Mir MC, Derweesh I, Porpiglia F, Zargar H, Mottrie A, Autorino R. Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1b and T2 Renal Tumors: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol. 2017;71(4):606-617. DOI: 10.1016/j.eururo.2016.08.060
9. Jiang YL, Peng CX, Wang HZ, Qian LJ. Comparison of the long-term follow-up and perioperative outcomes of partial nephrectomy and radical nephrectomy for 4 cm to 7 cm renal cell carcinoma: a systematic review and meta-analysis. BMC Urol. 2019;19(1):48. DOI: 10.1186/s12894-019-0480-6
10. Thompson RH, Lane BR, Lohse CM, Leibovich BC, Fergany A, Frank I, Gill IS, Blute ML, Campbell SC. Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol. 2010;58(3):340-5. DOI: 10.1016/j.eururo.2010.05.047
11. Capitanio U, Terrone C, Antonelli A, Minervini A, Volpe A, Furlan M, Matloob R, Regis F, Fiori C, Porpiglia F, Di Trapani E, Zacchero M, Serni S, Salonia A, Carini M, Simeone C, Montorsi F, Bertini R. Nephron-sparing techniques independently decrease the risk of cardiovascular events relative to radical nephrectomy in patients with a T1a-T1b renal mass and normal preoperative renal function. Eur Urol. 2015;67(4):683-9. DOI: 10.1016/j.eururo.2014.09.027
12. Kaczmarek BF, Tanagho YS, Hillyer SP, Mullins JK, Diaz M, Trinh QD, Bhayani SB, Allaf ME, Stifelman MD, Kaouk JH, Rogers CG. Off-clamp robot-assisted partial nephrectomy preserves renal function: a multi-institutional propensity score analysis. Eur Urol. 2013;64(6):988-93. DOI: 10.1016/j.eururo.2012.10.009
13. Dryazhenkov I.G., Komlev D.L., Los' M.S. Factors of ischemic lesions in the kidney and its resection. Clinical medicine (Russian jornal). 2013;91(6):21–5. (In Russian). eLIBRARY ID: 19412134; EDN: QIURTJ
14. Becker F, Van Poppel H, Hakenberg OW, Stief C, Gill I, Guazzoni G, Montorsi F, Russo P, Stöckle M. Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol. 2009;56(4):625-34. DOI: 10.1016/j.eururo.2009.07.016
15. Levin A, Stevens PE. Summary of KDIGO 2012 CKD Guideline: behind the scenes, need for guidance, and a framework for moving forward. Kidney Int. 2014;85(1):49-61. DOI: 10.1038/ki.2013.444
16. Seregin A.A., Seregin A.V., Kolontarev K.B., Seregin I.V., Makhmadaliev A.I., Loran O.B. Preventive sutures in nonischemic laparoscopic partial nephrectomy. Description of S.P. Botkin City Clinical Hospital technique. Cancer Urology. 2022;18(3):35-40. (In Russian). DOI: 10.17650/1726-9776-2022-18-3-35-40
Review
For citations:
Seregin A.V., Loran O.B., Seregin A.A., Shustitskiy N.A., Seregin I.V., Bessolova O.V., Indarokov T.R. Possibilities and features of zero-ischemia nephron-sparing surgery in localized kidney cancer. Urology Herald. 2023;11(2):188-202. (In Russ.) https://doi.org/10.21886/2308-6424-2023-11-2-188-202
Views:
921
Email this article 
