Functional results of kidney laser resection
Firsov K.A.1, Stakhanov M.L.1, Gorchak Yu.Yu.1, Ishevsky G.B.1,2, Anikanov E.V.2
1 A.I. Evdokimov Moscow State University of Medicine and Dentistry
2 Onkological Center of the Central Clinical Hospital No. 2 named after O.N. Semashko of the Russian Railways, Moscow
Aim: to improve the long-term functional results of surgical treatment of patients with stage I kidney cancer.
Patients and Methods: 103 patients with stage I kidney cancer were included in the study. Conventional laser kidney resection with arresting the intraorganic blood flow was performed in 55 (53.4%) patients. Nonischemic resection of the kidney with the use of high-energy laser radiation with 970 nm wavelength was performed in 48 (46.6%) patients. Patient groups were comparable in terms of sex, age, side of lesion, mean tumor size and resected segments, as well as concomitant diseases that reduced renal function, p>0.05. The renal function was assessed before the surgery, on the 7th day, and in 6, 12, 36 months after the surgery using the estimated GFR CKD (Chronic Kidney Desease Epidemiology Collaboration) and classified by the modified Kidney Disease Outcomes Quality Initiative (KDOQI) classification. Also, GFR was assessed depending on the presence / absence of concomitant diseases affecting kidney function.
Results: in 6 and 36 months after the surgery patients of the study group with concomitant diseases affecting renal function had significantly higher GFR (p=0.008 and p=0.0101, respectively), it was 86.0±13,4 ml/min/1.73 m2 (53 to 104) and 84.0±13,0 ml/min/1.73 m2 (51 to 102), as compared to that in the traditional operation group — 77.0± 14.3 ml/min/1.73 m2 (35 to 93) and 75.0±14.4 ml/min/1.73 m2 (35 to 92). Chronic kidney disease of stages III and IV in the long-term postoperative period (after 36 months) was more often found in patients after conventional kidney resection (10.8%) than in patients after laser surgery with the use of the developed technique (4.2%).
Conclusions: Laser kidney resection improves the long-term functional results of treatment of patients with stage I kidney cancer with concomitant pathology, which negatively affects kidney function.
Key words: stage I kidney cancer, laser resection, laser radiation, kidney parenchymal ischemia, glomerular filtration rate, chronic kidney disease.
For citation: Firsov K.A., Stakhanov M.L., Gorchak Yu.Yu. et al. Functional results of kidney laser resection // RMJ. Medical Review. 2018. № 2(I). P. 8–12.
References
1. Globocan 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwidein [Electronic resource] // 2012. http://globocan.iarc.fr/Pages/fact_sheets_population.aspx
2. Каприн А. Д. Состояние онкологической помощи населению России в 2016 году. Под ред. А. Д. Каприна, В. В. Старинского, Г. В. Петровой. М.: МНИОИ им. П. А. Герцена – филиал ФГБУ НМИРЦ Минздрава России, 2017. 236 с. [Kaprin A. D. Sostoyanie onkologicheskoj pomoshchi naseleniyu Rossii v 2016 godu. Pod red. A. D. Kaprina, V. V. Starinskogo, G. V. Petrovoj. M.: MNIOI im. P. A. Gercena – filial FGBU NMIRC Minzdrava Rossii, 2017. 236 s. [in Russian)].
3. Demirjian S., Lane B. R., Derweesh I. H. et al. Chronic kidney disease due to surgical removal of nephrons: relative rates of progression and survival // J. Urol. 2014. Vol. 192. P.1057–1063.
4. Ljungberg B., Albiges L., Bensalah K. et al. Guidelines on Renal Cell Carcinoma B. Ljungberg // Eur. Ass. Urol. 2017. P.24–25.
5. O’Connor, P. M. Renal oxygen delivery: matching delivery to metabolic demand // Clinical and Experimental Pharmacology and Physiology. 2006. Vol. 33. Is. 10. P.961–967.
6. Simmons M. N., Schreiber M. J., Gill I. S. Surgical renal ischemia: a contemporary overview // J. Urol. 2008. Vol. 180. Is. 1. P.19–30.
7. Mir M. C., Ercole C., Takagi T. et al. Decline in renal function after partial nephrectomy: etiology and prevention // J. Urol. 2015. Vol. 193. P.1889–1898.
8. Smith G. L., Kenney P. A., Lee Y. et al. Non-clamped partial nephrectomy: techniques and surgical outcomes // BJU Int. 2010. Vol. 107. P.1054–1058.
9. Kopp R. P., Mehrazin R., Palazzi K. et al. Factors affecting renal function after open partial nephrectomy – a comparison of clampless and clamped warm ischemic technique // Urology. 2012. Vol. 80. P.865–870.
10. Thompson R. H., Lane B. R., Lohse C. M. et al. Comparison of warm ischemia versus no ischemia during partial nephrectomy on a solitary kidney // Eur. Urol. 2010. Vol. 58. P.331–336.
11. Takagi T., Kondo H., Tachibana et al. A propensity score-matched comparison of surgical precision obtained by using volumetric analysis between robot-assisted laparoscopic and open partial nephrectomy for T1 renal cell carcinoma: a retrospective non-randomized observational study of initial outcomes // Int Urol Nephrol. 2016. Vol. 48. Is. 10. P.1585–1591.
12. Mir M. C., Derweesh I., Porpiglia F. et al. Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1b and T2 Renal Tumors: A Systematic Review and Meta-analysis of Comparative Studies // Eur Urol. 2017. Vol. 71. Is. 4. P.606–617.
13. Mir M. C., Takagi T., Campbell R. A. et al. Poorly functioning kidneys recover from ischemia after partial nephrectomy as well as strongly functioning kidneys // J. Urol. 2014. Vol. 192. P.665–670.
14. Zhang Z., Ercole C. E., Remer E. M. et al. Analysis of atrophy after clamped partial nephrectomy and potential impact of ischemia // Urology. 2015. Vol. 85. P.1417–1422.
15. Zhang Z., Zhao J., Velet L. et al. Functional recovery from extended warm ischemia associated with partial nephrectomy // Urology. 2015. Vol. 87. P.106–113.
16. Lane B. R., Campbell S. C., Demirjian S. et al. Surgically induced chronic kidney disease may be associated with a lower risk of progression and mortality than medical chronic kidney disease // J. Urol. 2013. Vol. 189. P.1649–1655.
17. Zabor E. C., Furberg H., Mashni J. et al. Factors Associated with Recovery of Renal Function following Radical Nephrectomy for Kidney Neoplasms // Clin J Am Soc Nephrol. 2016. Vol. 11. Is. 1. P.101–107.
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