Organ-preserving surgery of localized kidney cancer with preliminary superselective embolization of the tumor-feeding branch of renal artery.

Abstract

Introduction. Warm renal ischemia (WRI) is used during the organ-preserving surgery of localized renal cell carcinoma to reduce blood loss, improve the imaging quality, facilitate both accessing the cavitary system and suturing the parenchyma. However, WRI can lead to the ischemic reperfusion injury of the preserved nephrons. Superselective embolization (SSE) of the tumor-feeding branch of renal artery is currently being considered as the alternative method of intraoperative hemostasis. Aim. To evaluate the results of organ-preserving surgery of localized kidney cancer in the conditions of SSE. Materials and methods. Three patients who had undergone laparoscopic kidney resection (LKR) with SSE were included in the study. Parameters for assessment were as follows: surgery duration, surgery workflow, intraoperative blood loss volume, the degree of radical surgery according to the histological data, the presence of postoperative complications, and the duration of hospitalization. Results. Compared with the LKR with WRI (n=78, data from a previous own study), the features of the LRK with SSE (n=3) were as follows: 1) the same surgery duration; 2) three times less intraoperative blood loss; 3) the absence of infectious and inflammatory complications; 4) comparable duration of hospitalization. Also, additional advantages of the LKR with SSE were described: 1) the radicality of surgery; 2) the absence of the risk of renal pedicle injury; 3) the absence of the risk of ischemic reperfusion alteration of the preserved renal tissue. Conclusion. Preliminary SSE of the tumor-feeding branch of renal artery may improve functional results of the organ-preserving surgery of localized kidney cancer via reducing the intraoperative blood loss, exclusion the possibility of renal pedicle injury, and provision of the functional activity of the preserved nephrons.