Dumanskiy Yu.V., Molchanov R.M., Maltsev A.V., Reshetniak S.O.
New approaches in the treatment of localized kidney cancer. Personal experience
doi: https://doi.org/10.26641/2307-5279.28.1-4.2024.322081
Aim - to increase the effectiveness of organ-sparing surgical treatment of patients with localized kidney cancer by carefully studying the vascular anatomy of the kidney and its correlation with the tumor, preoperative embolization of segmental kidney vessels, and the use of intraoperative fluorescence angiography. We conducted a clinical prospective comparative (controlled) single-center cross-sectional study involving 65 patients with localized renal cell carcinoma (T1-2vN0M0), The comparison group included 40 patients, and the main group, respectively, included 25 patients. The minimum sufficient number of patients was determined by the standard methodology based on the appropriate statistical power. 25 patients (the main group) underwent retroperitoneoscopic (lumboscopic) kidney resection with preliminary targeted embolization of the renal artery branch supplying the part of the kidney to be resected, 40 patients (the comparison group) underwent laparoscopic or "open" kidney resection according to industry-specific national unified protocols and clinical guidelines. The results of instrumental studies 1 month after surgical treatment in both groups showed that 45% of patients had subclinical signs of postoperative inflammation in the operated kidney. In addition, in the comparison group, according to intravenous enhancement CT, 16 (40%) patients had impaired perfusion of the operated organ. These data confirm that the proposed algorithm for the treatment of patients with localized renal malignancy using preoperative selective renal vascular embolization and fluorescence imaging is safer and more appropriate for widespread implementation compared to the standard method. The proposed method of retroperitoneoscopic resection using preoperative X-ray vascular embolization and intraoperative fluorescence imaging in the infrared spectral region using indocyanine green in patients with localized renal cancer has advantages over the standard method of surgical treatment and can be used in this patient population.