Application and analysis of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for patients with multiple renal tumor: initial experience

Retroperitoneal laparoscopic partial nephrectomy for unilateral synchronous multifocal renal carcinoma with different pathological types: A case report

BACKGROUND

The majority of renal cell carcinomas are single lesions; unilateral synchronous multifocal renal carcinoma (USMRC) is rarely reported and poses a treatment challenge for urological oncologists.

CASE SUMMARY

A 56-year-old man was hospitalized for pain and discomfort in the right kidney area for 6 d. Contrast-enhanced computed tomography demonstrated cT1a renal tumors at the lower pole of the right kidney and a cT1b renal tumor at the middle dorsal portion of the right kidney. The patient underwent retroperitoneal laparoscopic partial nephrectomy (RLPN). There were no complications peri-operatively. Histopathology revealed a low-grade, pathologic stage T1a (pT1a), clear cell renal cell carcinoma at the lower pole of the right kidney and a pT1b, chromophobe renal cell carcinoma at the middle dorsal portion of the right kidney. No tumor bed recurrence or metastasis was observed on imaging and his renal function remained stable during the 12-mo follow-up period.

CONCLUSION

RLPN is a safe, effective, and feasible for the management of USMRC, which can obtain equivalent oncological results with optimal renal function preservation.

The efficacy evaluation of partial nephrectomy with selective renal artery branch occlusion by laparoscopy

BACKGROUND

To investigate the clinical application and effect of laparoscopic partial nephrectomy with renal artery branch occlusion in the treatment of early renal tumors.

METHODS

A retrospective analysis was conducted on the clinical data of 15 cases of renal tumor patients who underwent partial nephrectomy by laparoscopic selective renal artery branch occlusion in our department from January 2017 to January 2018. Nine male patients and 6 female patients were aged 46 to 65 years, with an average age of 54.3 ± 7.2 years. The diameters of tumors were 2.2 to 4.0 cm, with an average of 3.3 ± 0.7 cm. There are 10 tumors locating on the left side and 5 on the right side. Preoperative renal glomerular filtration rate (GFR) were 77.3 to 61.9 mL/min with an average of 47.6 ± 7.5 mL/min. All patients' diseased kidneys underwent renal computer tomography angiography examination before surgery. And the diseased kidney underwent reexamination of renal GFR. The operation time, renal artery branch occlusion time, intraoperative blood loss, postoperative hospital stay, changes of renal function, and complications were evaluated.

RESULTS

All surgery were completed successfully, the surgery time was 136.7 ± 15.2 min, intraoperative renal artery branch occlusion time was 21.3 ± 4.5 min, the intraoperative blood loss was 223.3 ± 69.5 mL, the postoperative hospital stay was 6.5 ± 1.7 days, and the postoperative 1-month GFR was 49.5 ± 6.6 mL/min. There was no significant difference between the renal GFR before and after surgery (P > .05). There was no blood transfusion and transfer open surgery cases. The patients were followed up for 3 to 15 months without complications.

CONCLUSIONS

Partial nephrectomy with selective renal artery branch occlusion by laparoscopy is a safe, feasible, and effective method for the treatment of early renal cancer. It makes good use of the technical advantages of clear operation field and fine operation of laparoscopic surgery, avoids the heat ischemia process of the whole kidney, and can better protect the renal function.

A retrospective study of open and endoscopic nephron sparing surgery in the treatment of complex renal tumors

Objective:

To investigate clinical outcomes of open and retroperitoneal laparoscopic nephron-sparing surgery in the treatment of complex renal tumours.

Methods:

A retrospective case study was conducted. Patients with complex renal tumours admitted to our hospital between January 2018 and September 2019 were enrolled; the included patients (n=40) were divided into the observation group (open partial nephrectomy, n=20) and control group (laparoscopic partial nephrectomy, n=20) according to operation modes. The operation time, renal warm ischaemia time, intraoperative blood loss, renal pedicle blocking time, intestinal function recovery time, postoperative hospital stay, and postoperative complications were recorded.

Results:

Significant differences were noted regarding renal warm ischaemia time, renal pedicle blocking time, intraoperative blood loss, operation time, and postoperative hospital stay between the observation and control groups (P<0.05); however, no significant difference was observed in intestinal function recovery time and postoperative drainage days (P>0.05).

Conclusion:

Open surgery remains the recommended surgical method for the treatment of few complex tumours in the renal hilus region and has gradually become the renal surgery of choice at present, although laparoscopic surgery has evolved tremendously.

Robotic-assisted partial nephrectomy with sequential clamping of segmental renal arteries for multiple ipsilateral renal tumors: initial outcomes

Background

To assess the technical feasibility and outcomes of robotic-assisted partial nephrectomy (RPN) with sequential segmental renal artery (SRA) clamping for multiple ipsilateral renal tumors (MIRTs).

Methods

From April 2016 to February 2018, consecutive eleven cases successfully underwent RPN with sequential SRA clamping under the guidance of dual-source computed tomography (DSCT).

Results

Ten cases had two lesions and two cases had three at the ipsilateral kidneys. The mean size and the mean R.E.N.A.L score for the dominant lesion of single case were 3.3 cm and 5.7, respectively. Twenty-two lesions (84.6%) had one target SRA and four (15.4%) had two target SRAs. Satisfactory ischemic areas were achieved by sequentially clamping two (81.8%) or three (18.2%) target SRAs with mean clamping time of 18.8 (15.0–27.0) min for single lesion, and the mean of total clamping time for single case was 37.5 (32.0–52.0) min. Only the complications of grade 1–2 were found and no positive surgical margin was discovered. The mean follow-up time was 5.4 months and no local recurrence or metastasis was found. The mean postoperative eGFR was 71.2 ml/minute/1.73m² that was only an insignificant reduction (9.3%) compared with the preoperative baseline.

Conclusion

This novel nephron-sparing technique, RPN with sequential SRA clamping, represents a good alternative for selected patients with MIRTs. With the guidance of DSCT and skilled robotic experience, this technique is feasible and can maximize renal function preservation. Large-scale multicenter clinical studies are still needed to further prove these initial outcomes.

Electronic supplementary material

The online version of this article (10.1186/s12894-019-0451-y) contains supplementary material, which is available to authorized users.

The correlation between affected renal function and affected renal residual volume: A retrospective outcome of laparoscopic nephron-sparing partial nephrectomy with segmental renal artery blocking-up for localized renal tumors

Laparoscopic nephron-sparing partial nephrectomy with segmental renal artery blocking (SRPN) has been widely used in the treatment of localized renal tumors. However, the impact of ischemia-reperfusion injury (IRI) during SRPN remains controversial. This study aims to evaluate the correlation between affected renal function and affected renal volume after SRPN for localized renal tumor treatment, explore the effect of IRI on renal function after SRPN.A total of 39 patients who underwent SRPN for localized renal tumor from June 2009 to April 2012 were reviewed. These patients were followed-up for 5 years. The preoperative affected renal glomerular filtration rate (aGFRpre), postoperative affected renal glomerular filtration rate (aGFRpost), preoperative affected renal volume (aVolpre), and postoperative affected renal volume (aVolpost) were collected during the follow-up period. The correlation between aGFRpost/aGFRpre and aVolpost/aVolpre was compared.A total of 33 patients were successfully followed up. After 3, 6, 12, 24, and 60 months, aGFRpost was 34.6 ± 4.6, 34.7 ± 4.8, 34.9 ± 4.4, 35.1 ± 4.4, and 35.2 ± 4.2 mL/min. The correlation coefficients between aGFRpost/aGFRpre and aVolpost/aVolpre were 0.659 (P = .000), 0.667 (P = .000), 0.663 (P = .000), 0.629 (P = .000), and 0.604 (P = .000), respectively. The limitation of this study was the small cohort size.For the localized renal tumor, aGFRpost was associated with aVolpost, but was not associated with intraoperative factors, such as the time of clamping of the affected segmental renal artery. As a part of nephrons, the resected tumor tissue caused the lack of inherent nephrons, resulting in the loss of renal function. More nephrons should be maintained before resecting the tumor completely during SRPN.Trial registration: ChiCTR-RRC-17011418.