Volume 5, 2021

Medical Imaging


Yulia A. Stepanova, Vlada Yu. Raguzina, Tatiana P. Baitman, Olesya A. Chekhoeva, Irina V. Miroshkina, Aleksandr A. Gritskevich

Pages: 141-147

DOI: 10.21175/RadProc.2021.27

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 organ-preserving 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 reno-caval 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 pharmaco-cold 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 treatment.
  1. Под ред. А.Д. Каприна, В.В. Старинского, Г.В. Петровой, Злокачественные новообразования в России в 2018 году (заболеваемость и смертность) , М.: МНИОИ им. П.А. Герцена - филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2019. (A.D. Caprin, V.V. Starinskiy, G.V. Petrova, Eds., Malignant neoplasms in Russia in 2018 (morbidity and mortality), Moscow: Moscow P.A. Gertsen Research Institute of Oncology, 2019.)
    Retrieved from: https://glavonco.ru/cancer_register/%D0%97%D0%B0%D0%B1%D0%BE%D0%BB_2018_%D0%AD%D0%BB%D0%B5%D0%BA%D1%82%D1%80.pdf
    Retrieved on: Aug. 15, 2021
  2. M. Tanaka et al., “Prognostic factors of renal cell carcinoma with extension into inferior vena cava”, Int. J. Urol., vol. 15, no. 5, pp. 394-398, May 2008.
    DOI: https://doi.org/10.1111/j.1442-2042.2008.02017.x
  3. T.K. Choueiri et al., “Updated efficacy results from the JAVELIN Renal 101 trial: first-line avelumab plus axitinib versus sunitinib in patients with advanced renal cell carcinoma”, Ann. Oncol., vol. 31, no. 8, pp. 1030–1039, Aug. 2020.
    DOI: https://doi.org/10.1016/j.annonc.2020.04.010
  4. E. Shapiro, D.A. Goldfarb, M.L. Ritchey, “The congenital and acquired solitary kidney”, Rev Urol., vol. 5, no. 1, pp. 2–8, 2003.
    PMid: 16985610
    PMCid: PMC1472993
  5. E. Tantisattamo et al., “Current Management of Patients with Acquired Solitary Kidney”, Kidney International Reports, vol. 4, no. 9, pp. 1205–1218, 2019.
    DOI: https://doi.org/10.1016/j.ekir.2019.07.001
  6. P.K.-T. Li et al., “Kidney Health for Everyone Everywhere – From Prevention to Detection and Equitable Access to Care”, Kidney Diseases, vol. 6, no. 3, pp. 136–143, 2020.
    DOI: https://doi.org/10.1159/000506528
  7. S. Groen in't Woud, L. van der Zanden, M.F. Schreuder, “Risk stratification for children with a solitary functioning kidney”, Pediatric Nephrology, vol. 36, pp. 3499–3503, 2021.
    DOI: https://doi.org/10.1007/s00467-021-05168-8
  8. А.А. Теплов и др., «Метод экстракорпоральной резекции почки в условиях фармако-холодовой ишемии без пересечения мочеточника с ортотопической реплантацией сосудов при почечно-клеточном раке», Экспериментальная и клиническая урология, № 2, с. 52–62, 2015. (A.A. Teplov et al., “The method of extracorporeal resection of the kidney in conditions of pharmaco-cold ischemia without crossing the ureter with orthotopic replantation of vessels in renal cell carcinoma”, Experimental and Clinical Urology, vol. 2, pp. 52–62, 2015.)
    Retrieved from: https://readera.org/142188379
    Retrieved on: Aug. 15, 2021
Yulia A. Stepanova, Vlada Yu. Raguzina, Tatiana P. Baitman, Olesya A. Chekhoeva, Irina V. Miroshkina, Aleksandr A. Gritskevich, "Ultrasound diagnostics at the stages of extracorporeal resection of a single kidney in the treatment of renal cell carcinoma ",RAD Conf. Proc, vol. 5, 2021, pp. 141-147, http://doi.org/10.21175/RadProc.2021.27