Extracorporeal resection of the kidney in the setting of the pharmacological and cold temperature ischemia with orthotopic replantation of the vessels without ureter transaction in patients with renal cell carcinoma

Teplov A.A., Grickevich A.A., P'yanikin S.S., Zotikov A.E., Adyrhaev Z.A., Kozhanova A.V., Askerova A.N., Vetsheva N.N., Timina I.E., Stepanova A.Yu., Karmazanovskiy G.G., Pokrovskiy A.V., Kubyshkin V.A.

Treatment of the renal cell carcinoma with parenchymatous and central localization in single or single functioning kidney, and although in case of significant pathology of contralateral kidney is a hard challenge.

Aim of the study: the development of the technique of extracorporeal kidney resection with pharmacological and cold temperature ischemia and orthotopic replantation of vessels without the transection of the ureter in patients with renal cell cancer (RCC).

Materials and methods. Thirty-seven patients with confirmed RCC and range of stages pT1a-T3bN0M0-1G1-3 with intraparenchymatous and central localization of tumor and concurrent pathology of contralateral / both kidneys, and 6 patients with RCC and anatomical and functional single kidneys we included in this study. Mean age was 55.3±13.1 years.

Results. Mean operation duration was 413.97±89.14 min. Mean warm ischemia time was 8.39±4.75 min. Cold ischemia time was 151.41±41.29 min (range 70-240 min). Mean blood loss was 729±481 ml. Intraoperative complications were evident in 3 patients (8.1%): in 2 cases renal unit was non-viable after inclusion into systemic circulation and was removed. One case of the renal artery thrombosis has developed with the consequent shrinkage of the kidney. Postoperative complications were revealed in 18 patients (48.6%).

Conclusions. The investigated method of ex vivo resection is relatively safe. Prolonged controlled cold ischemia allows the vascular and collection system reconstruction of all complexity levels. Tumors of all localization and of substantial size could be resected with this technique. The extension operations (simultant caval trombectomy and caval resection) are also possible with safe implementation. The investigated technique allows orthotopic localization of operated kidney without necessity of additional access, time loss due to dissection and autotransplantation in the iliac region, and uretero-uretero or uretero-cysto anastomosis.

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