SIU 2017: Local Ischemia as an Alternative to Thermal in Kidney Resection

Lisbon, Portugal ( Partial nephrectomy in renal cell carcinoma provides good overall survival, but the use of central ischemia that promotes radical removal of the tumor and adequate hemostasis leads to irreversible changes in the kidneys that can lead to loss of function and possibly to the development of chronic renal failure. The authors aimed to evaluate the effectiveness of local ischemia rather than central ischemia during partial nephrectomy and assess its impact on kidney function. 

This was a retrospective analysis of 229 patients with renal cell carcinoma who underwent partial nephrectomy. Age ranged from 25 to 83 years (mean 56.3). Tumor size ranged from 10 to 208 mm (mean 55.3). The impact of the ischemia type (either local or central) on the amount of bleeding and kidney functional status was assessed. Two groups of patients were compared: the first group included 107 (46.7%) patients in whom surgery was performed with the standard central ischemia lasting from 5 to 21 min (mean 9.9), and the second group - 122 (53.3%) patients where local ischemia was utilized. 

In local ischemia, prior to the actual resection of the tumor, two sutures were passed under the tumor base. Then the ends of the sutures are tied, creating the zone of local ischemia. After the resection was completed, and the defect is closed, the sutures are removed.

Surgery was performed both open and laparoscopically. No statistically significant difference in tumor size (46.7 + 22.9 vs. 46.9 + 25.6mm) was noted. Intraoperative blood loss was similar as well (340.4 + 129.2 and 353.4 + 235.2 ml). No difference was found in the rate of intra- and postoperative complications between the 2 groups (9 (8.4%) and 10 (8.2%) cases, respectively, p=0.9). Central ischemia significantly reduced GFR function in the postoperative period: during 3 months - by 25.9%, and in 1 year-by 28.5%. However, after 1 year from surgery, kidney function did not differ significantly between the groups and was close to initial GFR.

The authors concluded that local ischemia during partial nephrectomy, whether laparoscopically or open, obtains the same good level of hemostasis as in central ischemia, is safe, feasible, and leads to less deterioration of renal function following surgery.

Presented by: Iurii Vitruk
Affiliation: Deptartment of Plastic and Reconstructive Oncourology, National Cancer Institute, Kyiv, Ukraine

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal