RESULTS OF EXTRACORPOREAL NEPHRON-SPARING SURGERY FOR RENAL CELL CARCINOMA WITH AUTOTRANSPLANTATION

Abstract

The study included 12 patients who underwent extracorporeal nephron-sparing surgery followed by autotransplantation of the kidney to the iliac region. A solitary kidney occurred in 7 (58.3%) cases, bilateral tumors in 2 (16.7%) cases, a significant decrease in the function of the contralateral kidney in 2 (16.7%) cases, and relative imperative indications in 1 (8.3%) patient. The ECOG status 0, 1 and 2, respectively, was recorded in 3 (25%), 6 (50%) and 3 (25%) cases. The glomerular filtration rate in patients (GFR) averaged 51.5±16.8 ml/min, the blood creatinine level was 157.9±58.2 µmol/L, and the body mass index (BMI) was 27.7±4.9 kg/m2. The average size of tumors in the entire group reached 5.6±1.8 cm (3 to 9 cm). T1 stage was registered in 6 cases, T3a was diagnosed in another 6 cases. Besides, invasion into the renal vein was detected in 4 patients, into the pararenal or renal sinus fat in another 4 patients, into the pelvicalyceal system lumen in yet another 4 patients. Intrarenal tumors were found in 11 (91.7%) patients. Different types of vascular reconstruction were required in 4 (30%) out of 12 patients. The average time of surgical interventions reached 270.8±25.0 minutes. The average cold ischemia time during extracorporeal partial nephrectomy was 47.8±7.8 minutes. The average overall time frame of vascular anastomosis was 56.4±6.4 minutes. The volume of blood loss varied from 400 to 700 ml (on average 558.3±99.6 ml). Postoperative complications Grade III-IV by Clavien-Dindo classification were recorded in 5 (41.7%) patients. Oligoanuria in the postoperative period occurred in 4 (33.3%) patients, but hemodialysis was necessary only in two of them. Postoperative mortality was observed in two (16.7%) cases. The graft loss rate was 16.7% (bleeding and chronic urinary fistula). Long-term results were evaluated in all 10 patients. Currently none of the patients requires chronic hemodialysis. The average creatinine level after surgery in the entire group was 139.3±46.1 µmol/L (from 102.4 to 260 µmol/L). Δ serum creatinine varied from 4.0 to 60.0 µmol/L (on average 25.3±17.6 µmol/L). Δ GFR on average did not exceed -9.3±8.6 ml/min. With an average follow-up period of 42 months, no locoregional RCC recurrences were detected in any of the cases. Metachronous metastases to the lungs were found in one patient 2 years after surgery. Extracorporeal removal of a kidney tumor with renal autotransplantation is an effective method of nephron-sparing surgery in patients with imperative indications for kidney preservation. However, this technique is accompanied by a high rate of complications Grade ≥ III-IV by Clavien-Dindo system, which must be taken into account while defining the indications for its use.