Ex-vivo nephron-sparing surgery and autotransplantation for renal tumours: Revisited

Abstract

Introduction: We studied the feasibility of ex-vivo nephron-sparing surgery and autotransplantation for complex renal tumours. We also studied the role of laparoscopy in these situations. Methods: All patients who underwent renal autotransplantation for renal tumour at our centre were included in this retrospective study. Patient profiles were recorded in detail. Operative and postoperative details were also recorded. Results: Our series includes 3 patients. Two patients had complex renal cell carcinoma and 1 patient had bilateral large angiomyolipoma. In first 2 patients, laparoscopic approach was used for nephrectomy. Operative time for case 1, 2 and 3 was 5.5, 4.5, 8 (right side) and 6 (left side) hours, respectively. Cold ischemia time was 110, 90, 150 and 125 minutes, respectively. One patient required temporary postoperative hemodialysis. Conclusion: Ex-vivo nephron-sparing surgery and autotransplantation still remain a viable option for complex renal tumours. It offers satisfactory renal functional outcome with acceptable morbidity. The laparoscopic approach should be used whenever possible to reduce morbidity.

Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability

“…Previous reports have suggested LNA is an excellent long-term surgical option for complex ureteral pathology and severe renal disorder that necessitates preserving renal parenchyma. 2,7,10,14 To our knowledge this report represents the most robust data of the long-term safety, efficacy and durability of LNA. Our longterm (greater than 6-year median followup) experience validates the efficacy (greater than 90% preserved renal unit function) with acceptable (12%) late major complications.…”

“…Other investigators have reported similar outcomes of LNA in experienced hands but these involve short-term followup and low patient numbers. 10,11 Five autotransplanted renal units failed, necessitating graft nephrectomy in 4, of which 2 were due to tumor progression. Of the 5 cases that required nephrectomy due to vascular complications 1 was due to chronic pain (ureteral stricture group) and 1 in the tumor group had local recurrence after nephron sparing surgery.…”

“…Until recently several groups have reported feasibility and acceptable short-term outcomes but long-term outcomes and data on complications were lacking. 10,11 In this study we describe the long-term safety, efficacy and durability of LNA at our institution.…”

Minimally invasive renal autotransplantation

“…Tables and (part‐a) summarize the key studies reporting the use of ReATx in oncological settings. The indications for ReATx included centrally located or multiple renal masses in the scenario of bilateral renal involvement or solitary functioning kidney . Primary urothelial carcinoma (UC) of the renal pelvis or the ureter in the setting of bilateral neoplastic involvement or solitary functioning kidney was also a common indication .…”

“…Renal autotransplantation (ReATx), despite having been reported as an effective treatment modality for managing complex renal/ureteral lesions , has remained underutilized. Two reasons may be cited for it—first, the high morbidity associated with the procedure due to the requirement for two major interventions, open nephrectomy and open transplantation, in the same setting.…”