Resection of a kidney tumor with superselective targeted balloon-occluded chemoembolization

Objective: to develop a method of laparoscopic resection of a kidney tumor with super selective balloon occlusion of the segmental renal artery and targeted chemoembolization. Another purpose is to estimate the degree of fixation of the chemotherapy drug in the kidney parenchyma.

Materials and methods. The study included the results of experiments on 14 laboratory rabbits, who underwent an intra-arterial injection of the coloring substance of Ponceau S and there were determined its concentration in the renal parenchyma after fixation with a hemostatic suture for 8 days after the injection of the marker. Besides, there were included the results of 13 studies of the contrast substance of ultraravist and gadovist concentration in the renal tissue of patients after resection of the neoplasm with intra-arterial injection of the contrast substance into the parenchyma of the operated kidney.

Results. The implemented study showed the presence of a high concentration of a substance injected into the renal artery and a hemostatic suture fixed to the wound edges in the kidney tissue for 6-8 days of the postoperative period.

Conclusion. Laparoscopic resection of a malignant kidney tumor with a super-selective balloon occlusion of the segmental renal artery, supplemented by the injection of a targeted chemotherapy agent into the renal artery is a highly effective, safe and simple method of surgical treatment of kidney cancer with enhanced anti-relapse protection due to high concentrations of chemotherapy in the resection area.

1. Godley P.A., Taylor M. Renal cell carcinoma. Curr Opin Oncol 2001;13(3):199-203. DOI: 10.1097/00001622-200105000-00012.

2. Jemal A., Tiwari R.C., Murray T. et al. Cancer statistics. CA Cancer J Clin 2004;54(1):8-29

3. Ramani A.P., Desai M.M., Steinberg A.P. et al. Complications of laparoscopic partial nephrectomy in 200 cases. J Urol 2005;173(1):42-7. DOI: 10.1097/01.ju.0000147177.20458.73.

4. Kane C.J., Mallin K., Ritchey J. et al. Renal cell cancer stage migration: analysis of the National Cancer Data base. Cancer 2008;113(1):78-83. DOI: 10.1002/cncr.23518.

5. Mulders P. Continued progress in treatment of advanced renal cell carcinoma: an update on the role of Sunitinib. Eur Urol Suppl 2008;7(9):579-84.

6. Folkman J. What is the evidence that tumors are angiogenesis dependent? J Natl Cancer Inst 1990;82(1):4-6. DOI: 10.1093/jnci/82.1.4.

7. Rafii S., Lyden D., Benezra R. et al. Vascular and haematopoietic stem cells: novel targets for antiangiogenesis therapy? Nat Rev Cancer 2002;2(11):826-35. DOI: 10.1038/nrc925.

8. Ljungberg B., Cowan N.C., Hanbury D.C. et al. Guidelines on renal cell cancer. Eur Urol 2010;58(3):398-406. DOI: 10.1016/j.eururo.2010.06.032.

9. Maksimov A.V., Martov A.G., Pavlov L.P. et al. Laparoscopic partial nephrectomy with superselective balloon embolization of renal artery. Urologiya = Urology 2017;(1):31-6. (In Russ.). DOI: https://dx.doi.org/10.18565/urol.2017.1.31-36.

10. Kilkenny C., Browne W.J., Cuthill I.C. et al. Improving bioscience research reporting: the ARRIVE guidelines for reporting animal research. PloS Biol 2010;8(6)e1000412. DOI: 10.1371/journal.pbio.1000412.