Evaluation of renal function after partial nephrectomy for cancer

Introduction. Renal cancer is one of the leading urological cancers due to annually increasing morbidity and mortality rates for the last 10 years (29.39%), conceding in our country only prostate cancer. Aim of the study - to assess the functional results of nephron-sparing surgeries with a preventive hemostatic suture in patients with renal cell carcinoma using nephroscintigraphy and computed tomography. Material and methods. In 41 urological department of the S.P.Botkin City Clinical Hospital developed and implemented a new technique of partial nephrectomy with preventive hemostatic suture. Dynamic nephroscintigraphy was used to evaluate a renal function. Volume indexes was evaluated via contrast enhanced computed tomography (CT). Study included 150 patients with pT1a-pT2bN0M0 kidney cancers. Central tumor location was in 64 patients, 45 patients had upper segment tumors and 41 lower segment tumors. 74 patients had T1a tumor stage, T1b and T2a stage observed in 53 and 4 patients respectively. 19 tumors was cystic RCC’c. Results. All patients underwent nephron-sparing surgery. Mean operative time was 180±40 minutes, mean anesthesia time was 190.5±15 minutes. Mean blood loss was 250±70 ml. We didn’t used arteria clamping and warm ischemia and there was no conversions to nephrectomy during all partial nephrectomies. Perfusion index of the kidney before the surgery was 54.13±2%, after the surgery 46.23±3%, renal index was 53.24±4% and 46.82±2.39%, respectfully. In our opinion decreasing of renal indexes in early postoperative period is associated with loss of kidney parenchyma due to the surgery. Mean kidney volume was 140±30 cm3 with 120±20 cm3 functional parenchyma volume and mean tumor volume 40±20 cm3. Functional parenchyma volume after surgery insignificantly decreased to 115±20 cm3. Conclusion: preventive hemostatic sutures during partial nephrectomy allows to remove the tumor in almost any part of the kidney, At the same time, its vessels are not worn out, which makes it possible to protect the renal parenchyma from ischemic damage, thereby maximally preserving its function, as confirmed by nephroscintigraphy and CT.

renal cancer, kidney resection