Cold ischemia during laparoscopic partial nephrectomy for a complex tumor (RENAL SCORE-11): a clinical case in one institute

Abstract

Background. Depending on the stage or location of the tumor, kidney resection or nephrectomy is the gold standard of treatment for renal cell carcinoma Preservation of organ function is essential for patients with localized tumors, especially with one kidney, chronic kidney disease, proteinuria, or multiple/bilateral masses. An important goal of kidney resection is to preserve the functional activity of the organ; however, the surgery leads to its decrease because of the loss of vascularized nephrons and irreversible ischemic damage. Description of the clinical case. A 24-year-old female was diagnosed with cT1bN0M0, Stage I right kidney cancer. An abdominal cavity and retroperitoneal MSCT with intravenous contrast showed a mass in the right kidney, extending into the renal sinus and causing pyelocalicoectasia. A laparoscopic resection of the right kidney was performed using the patented technique developed at the P.A. Herzen Moscow Oncology Research Institute and providing selective intra-arterial cold ischemia. This was prompted by the complex tumor anatomy, which indicated a prolonged kidney ischemia. Conclusion. Cold arterial perfusion has several advantages. First, it quickly cools the renal parenchyma to 25 °C, enabling faster and more comfortable kidney resection and suturing. Second, it eliminates the reverse venous blood fow caused by the positive perfusion pressure in the collecting system. Third, it does not imply the additional objects (for example, ice or clamps) in the work area, therefore not affecting the intraoperative view. The literature suggests hypothermia as the method of choice in most diffcult cases (resection of a single kidney, a large-diameter tumor, a high R.E.N.A.L. index).

Keywords

• renal cell carcinoma
• selective “intra-arterial” cold ischemia
• laparoscopic partial nephrectomy
• intrasinus tumor of the kidney