Modification of fast-track surgery during partial nephrectomy

Abstract

The present study aimed to assess the efficacy of the multimodal fast-track surgery (FTS) program supplemented with the exclusion of renal thermal ischemia, urinary tract drainage, and postoperative wound management in patients undergoing partial nephrectomy for localized T1 RCC. Methods. A total of 150 patients diagnosed with localized RCC in stage T1 N0 M0 were initially enrolled in this prospective randomized study, with 75 patients assigned to each study group. Patients undergoing perioperative management following the FTS program were randomly assigned to the main study group. The control group comprised patients receiving standard postoperative care. The study specifically involved patients with kidney neoplasms not exceeding 7 cm in the largest diameter based on computed tomography data. Tumor size, localization, and the volume of functioning parenchyma were considered in the assessment. Results. Among the patients included, 24 cases (16%) underwent radical nephrectomy due to technical difficulties arising from tumor spread to the kidney hilum, rendering them ineligible for further analysis. Consequently, the clinical analysis focused on 126 patients. Within the main group, 64 cases (50.8%) of RCC underwent randomization, and the multimodal FTS program was applied during partial nephrectomy. The control group comprised 62 patients (49.2%). The median postoperative bed day in the main group was 1.5 days less compared to the control group, with values of 3.2 [2; 4] days versus 5 [4; 7] days, respectively (p < 0.001). Intraoperative complications occurred in 5 cases (4.0%) involving blood loss exceeding 1 liter (4 cases in the main group and 1 case in the control group). Transfusion of blood components occurred only once when the hemoglobin level dropped below 70 g/l. In the early postoperative period, a total of 9 complications (7.1%) were observed with pyelonephritis lasting more than 3 days diagnosed in 4 cases (3.2%) and wound suppuration in 1 case (0.8%). Despite the absence of drainage in postoperative wounds within the main group, ultrasound examinations revealed small retroperitoneal hematomas (up to 100 ml) requiring drainage in 3% of cases. Conclusions. The multimodal FTS program for patients with localized RCC during partial nephrectomy, coupled with the exclusion of central thermal ischemia of the kidney, avoidance of retroperitoneal space drainage, and early patient activation, demonstrated a significant reduction in postoperative bed while maintaining a comparable level of perioperative complications.

Keywords

• kidney cancer, fast-track surgery, program, partial nephrectomy.