Ultrasound Diagnostics at the Stages of Extracorporeal Resection of a Single Kidney in the Treatment of Renal Cell Carcinoma

Abstract

An organ-sparing approach is preferable at the treatment of patients with cancer of a solitary kidney, but doesn't always comply with the oncological radicalism. The technique of extracorporeal renal resection followed by autologous transplantation was developed to preserve renal function in patients with obligatory indications for organpreserving treatment. The aim is to evaluate the possibilities of ultrasound (US) at the stages of extracorporeal resection of a single kidney in the treatment of renal cell carcinoma. Materials and methods. The study included 22 patients treated with renal cell carcinoma of a single kidney in 2013-21 (average age 60.45±7 years). Men prevailed (73%). Multiple primary metachronous cancer occurred in 16 (73%) cases, multiple primary synchronous cancer -in 2 (9%), previous nephrureterectomy was performed in connection with benign kidney diseases (primary contracted kidney, hydronephrosis) -in 2 (10%), a congenital single kidney was in 2 (10%) patients. Previously underwent surgery on a single kidney for a malignant neoplasm of the same etiology for which 6 (27%) patients are being treated in this hospitalization. All the patients underwent US examination in B-mode and duplex scanning at the pre-/intra-and postoperative stage. If necessary, echo-contrast US (Sonovue) was performed intraoperatively and in the early postoperative period. Also, all patients underwent preoperative contrast-enhanced multidetected computed tomography (MDCT). MRI was performed in 7 cases. All the patients were operated with histological verification. Results. Staging according to the TNM system: pT1a-T3vN0-2M0-1G1-3, of which the tumor size exceeded 7 cm in 10 (50%) patients, distant metastases were in 8 (40%) cases. Reno-caval tumor thrombus was detected in 3 patients. Intraoperative US was performed at the stages of surgery: navigation to the stage of resection and assessment of the restoration of blood supply in the intervention area after kidney resection and wound closure. In 3 cases, extracorporeal renal resection was performed simultaneously with thrombectomy and resection of the inferior vena cava for renocaval tumor thrombus. In 4 cases, renal vessel replacement was performed. The tumor involved vessels in 3 cases and in 1 IOUS after resection showed thrombosis of the renal artery, which eventually required prosthetics. There were no intraoperative complications. All patients underwent US-monitoring on the 1st, 3rd and 5th days after surgery, more often and further as needed. The follow-up period (US, MSCT) was 19-85 months (53.3±17.2). Tumor progression occurred in 3 (15%) cases. One patient died due to the progression of the tumor process 20 months after the operation. Conclusion. US make it possible to control all the stages of extracorporeal resection of a single kidney under pharmacocold anti-ischemic protection with orthotopic replantation of renal vessels. The results of this surgical intervention are satisfactory, which indicates the advisability of further development of organ-saving treatm...