Photodynamic diagnostics of surgical margins during partial nephroectomy for kidney cancer

Chernyshev I.V., Roschin D.A., Samsonov Yu.V., Altunin D.V., Hanakaev R.A.

The main criteria for the efficacy estimation of the organ-preservation surgery in patients with kidney cancer (KC) is the incidence of local recurrences and survival outcomes. The main cause of the local recurrence is non-radical manner of excision and multifocal tumor growth. Our study included 56 patients with KC which were treated operatively: 20 (35.7%) patients with open partial nephrectomy, 36 (64.2%) patients with laparoscopic partial nephrectomy. As photosensibilizer ‘Alasens’ (Russia) was used (5- aminolevulenic acid). Spectroscopic assessment of fluorescence was performed with the use of laser spectral apparatus LESA-01-BIOSPEK. In forty seven patients (84%) a positive fluorescence was not evident in the area of the surgical margin, which was confirmed also as the histologically apparent absence of tumor tissue in the margin. In 9 patients (16%, 4 patients with open, 5 with laparoscopic operation) positive fluorescence of the surgical margin was detected. In 7 patients (12%) of this group positive surgical margin was found the result of pathomorphological investigation, in 2 patients (3%) a conclusion of false luminescence was made with angiomyolipoma as a finding at pathomorphology. The sensitivity of the method was found to be 78%, specificity – 84%. Drawing a conclusion, a high efficacy was shown for fluorescence as a method of the radicalism control during the organ-preserving operations kidney. This accounts for a decrease in the risk of local recurrence and, consequently, for a better survival.

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