Analysis of long-term results of protective therapy during the post-operative period after kidney resection due to renal cell carcinoma

Shormanov I.S., Los' M.S.

Introduction. The issue of anti-ischemic protection of the kidney is of paramount importance in the era of organ-saving surgeries.

Materials and methods. Our clinical study is based on case records of 69 patients with clear cell renal cell carcinoma (ccRCC) at the stage T1N0M0, who underwent organ-saving elective surgery. During the post-operative period, patients (n=35) received hyperbaric oxygen therapy combined with alpha tocopheryl acetate administration. In order to evaluate the proposed complex post-operative impact on hemodynamics and kidney function, and also on the quality of life in the long-term, we examined those patients 6 months after their discharge. Kidney function was evaluated by measuring the glomerular filtration rate, organ blood flow and by angionephroscintigraphic assays. Organ blood flow was measured by studying the indicators of peripheral resistance of intralobular and curved vessels of the kidney. The indicators of cellular and humoral immune responses were also analyzed, as well as the SF-36 scale.

Results and discussion. According to the data collected from Doppler ultrasonography, we have registered a significant increase of peripheral resistance in the group receiving complex post-operative therapy (CPT group) 6 months aer the surgery. Kidney blood flow was reduced by 16.3±1.4% in the group receiving standard postoperative therapy (SPT group), and by 10.1±1.2% in the CPT group. The indicators of cellular and humoral immune responses in patients from both groups did not differ. The mean values of glomerular filtration rate were 109.2±3.51 and 108.4±4.27 in the SPT and CPT groups, respectively (p<0.005). The mean value of Tmax was lower in the CPT group (p=0.004). Life quality assessment revealed that the level of psychological well-being was significantly higher in the CPT group. Exacerbation of chronic pyelonephritis was recorded in 5 patients from the SPT group (14.7%) and in one patient from the CPT group (2.9%).

Conclusion. According to the long-term results we obtained, complex application of hyperbaric oxygen therapy combined with alpha tocopheryl acetate administration during the early post-operative period promotes a better recovery of blood flow of the organ operated and its function, and also improves the well-being of patients after the surgery.

Authors declare lack of the possible conflicts of interests.

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kidney resection, kidney cancer, anti-ischemic protection, hyperbaric oxygenation, α-Tocopherol acetate, kidney function, postoperative period

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