Preventive hemostatic suture during open kidney resection as an option to preserve the renal function

Introduction. Renal cancer is one of the leading urological cancers due to annually increasing morbidity and mortality rates.

Objective: to prove the efficiency of preventive hemostatic sutures during partial nephrectomy for maximal preservation of functional renal parenchyma in patients with renal cell carcinoma.

Materials and methods. We developed and implemented a new technique of partial nephrectomy with preventive hemostatic suture, that allows not to clamp the renal pedicle, even in case of central tumor location. Main benefit of this technique is minimization of kidney function loss after the operation, which is the major aim of nephron sparing surgery. Study included 150 patients with pT1a–pT2bN0M0 kidney cancers. Central tumor location was in 64 patients, 45 patients had upper segment tumors and 41 lower segment tumors. 74 patients had T1a tumor stage, T1b and T2a stage observed in 53 and 4 patients respectively. Nineteen patients were diagnosed with cystic carcinoma. To evaluate renal function, dynamic nephroscintigraphy was carried out and volume indices were calculated by computed tomography data.

Results. All patients underwent nephron sparing surgery using preventive hemostatic sutures. Mean operative time was 180 ± 40 minutes, mean anesthesia time was 190.5 ± 15.0 minutes. Mean blood loss was 250 ± 70 ml. We didn’t used arteria clamping and warm ischemia and there was no conversions to nephrectomy during all partial nephrectomies. Perfusion index of the kidney before the surgery was 54.13 ± 2.00 %, after the surgery 46.23 ± 3.00 %, renal index was 53.24 ± 4.00 % and 46.82 ± 2.39 %, respectfully. In our opinion decreasing of renal indexes in early postoperative period is associated with loss of kidney parenchyma due to the surgery. Mean kidney volume was 140 ± 30 cm3 with 120 ± 20 см3 functional parenchyma volume and mean tumor volume 40 ± 20 сm3. Functional parenchyma volume after surgery insignificantly decreased to 115 ± 20 сm3.

Conclusion. Preventive hemostatic sutures during partial nephrectomy allows to remove the tumor in almost any part of the kidney. Rejection of renal hilum clamping minimizes ischemical damages of renal parenchyma.

1. Алексеев Б. Я., Нюшко К. М., Калпинский А. С. Применение сунитиниба в реальной клинической практике у больных метастатическим раком почки. Онкоурология 2016;12(1):14–20. [Alekseev B.Ya., Nyushko K. M., Kalpinskiy A. S. Use of sunitinib in patients with metastatic kidney cancer in real clinical practice. Onkourologiya = Cancer Urology 2016;12(1):14–20. (In Russ.)]. DOI: 10.17 650/1726-9776-2016-12-1-14-20.

2. Аляев Ю. Г., Ахвледиани Н. Д., Фиев Д. Н., Петровский Н. В. Возможности методов визуализации в диагностике и мониторинге опухоли почки. Экспериментальная и клиническая урология 2011;(2–3):96–7. [Alyaev Yu. G., Akhvlediani N. D., Fiev D. N., Petrovskiy N. V. Possibilities of imaging techniques in the diagnosis and monitoring of kidney tumors. Eksperimental’naya i klinicheskaya urologiya = Experimental and Clinical Urology 2011;(2–3):96–7. (In Russ.)].

3. Серегин А. В. Органосохраняющие операции при раке почки. Автореф. дис. ... д-ра мед. наук. М., 2002. [Seregin A. V. Organ-preserving surgery for kidney cancer. Author’s abstract of thesis … of doctor of medical sciences. Moscow, 2002. (In Russ.)].

4. Иванов А. П., Чернышев И. В., Тюзиков И. А. Оптимизация протокола спиральной компьютерной томографии при диагностике опухолей почки. Онкоурология 2011;7(2):18–21. [Ivanov A. P., Chernyshev I. V., Tyuzikov I. A. Optimization of spiral computed tomography protocol in the diagnosis of renal tumors. Onkourologiya = Oncourology 2011;7(2):18–21. (In Russ.)].

5. Гусев А. А., Евсеев С. В., Коган М. И. Оценка почечных функций и оперативное лечение почечно-клеточного рака. Онкоурология 2013;9(1):17–23. [Gusev A. A., Evseev S. V., Kogan M. I. Evaluation of renal functions and surgical treatment for renal cell carcinoma. Onkourologiya = Cancer Urology 2013;9(1):17–23. (In Russ.)]. DOI:10.17650/1726-9776-2013-9-1-17-23.

6. Thompson R. H., Lane B. R., Lohse C. M. et al. 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. PMID: 20825756.

7. Capitanio U., Terrone C., Antonelli A. et al. 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. PMID: 25282367.

8. Kaczmarek B. F., Tanagho Y. S., Hillyer S. P. et al. 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. PMID: 23122834.

9. Дряженков И. Г., Комлев Д. Л., Лось М. С. Факторы ишемического повреждения почки при ее резекции. Клиническая медицина 2013;91(6):21–5. [Dryazhenkov I. G., Komlev D. L., Los’ M. S. Factors of ischemic injury of the kidney when it is resected. Klinicheskaya meditsina = Сlinical Medicine 2013;91(6):21–5. (In Russ.)].

10. Becker F., Van Poppel H., Hakenberg O. W. et al. Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol 2009;56(4):625–35. DOI: 10.1016/j.eururo.2009.07.016. PMID: 19656615.