Advantages of selective ischemia and indocyanine green fluorescence navigation in laparoscopic partial nephrectomy: preliminary results

Authors

DOI:

https://doi.org/10.26641/2307-5279.26.2.2022.279555

Keywords:

kidney tumor, partial nephrectomy, segmental ischemia, indocyanine green

Abstract

An important stage of the nephron-sparing surgery for the treatment of kidney tumors is the temporary creation of thermal ischemia, which can lead to a further decrease in kidney function, therefore this stage needs to be optimized. The aim of our work was to investigate the benefits of using segmental ischemia using intraoperative indocyanine green (ICG) navigation for kidney resection in patients with kidney tumors. The prospective study included 73 patients diagnosed with a kidney tumor who underwent partial nephrectomy (PN). Patients were divided into three groups, according to the use of the thermal ischemia method: total ischemia by clamping the main renal artery (n=33), segmental ischemia by clamping the segmental artery with the use of ICG navigation (n=26), and without it (n=16). Demographic, physiological, and perioperative data were analyzed for all patients. Before and on the fourth day after surgery, the glomerular filtration rate was evaluated according to the level of blood creatinine – eGFR (calculated glomerular filtration rate (eGFR). Multiple linear regression was used to model the effect of variables on change in eGFR. The data testify to the significant index difference in eGFR level change on the fourth postoperative day in the groups of total and segmental ischemia in favor of the latter (p=0.001). A decrease in eGRF was associated with the length of hospital stay (p=0.021). The data stratification in tumor size showed that it is the most important factor defining eGFR level change during total or segmental ischemia application. Renal tumor localization influences eGFR level change during the postoperative period for a maximum diameter of <40 mm tumors. However, for >40 mm diameter tumors, the statistically significant index of eGFR deviation was not found. At the same time, in the patient group with >40 mm tumors, there was a notable difference in eGFR deviation among the groups of total and segmental ischemia (about 15 mL/min/1.73 m2). In the early postoperative period (up to 4 days) after partial nephrectomy using selective warm ischemia, less pronounced eGFR deviations are observed compared to total warm ischemia. Tumor size and its localization are the risk factors for eGFR level decline in the early postoperative period. We did not find any statistically significant differences in intra- and early postoperative indexes for groups II and III patients where segmental ischemia was applied either with indocyanine green fluorescence imaging or without it.

References

Asghar, A. M., McIntosh, A. G., Smith, Z. L., Kocher, N. J., Lee, Z., Barashi, N. N., ... Kuti-kov, A. (2021). Pathological characteristics of the large renal mass: potential implication for clinical role of renal biopsy. Can J Urol, 28(2), 10620-10624.

Ballard, B. D., & Guzman, N. (2022). Renal Mass. In StatPearls. Treasure Island (FL).

Borrego Utiel, F. J., Ramirez Navarro, A. M., Esteban de la Rosa, R., & Bravo Soto, J. A. (2020). Comparison of MDRD and the old CKD-EPI equations with the new CKD-EPI equations in kidney transplant patients when glomerular filtration rate is measured with 51Cr-EDTA. Nefrologia (Engl Ed), 40(1), 53-64. https://doi.org/10.1016/j.nefro.2019.07.006

Campbell, S. C., Uzzo, R. G., Karam, J. A., Chang, S. S., Clark, P. E., & Souter, L. (2021). Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-up: AUA Guideline: Part II. J Urol, 206(2), 209-218. https://doi.org/10.1097/JU.0000000000001912

Carbonara, U., Simone, G., Minervini, A., Sundaram, C. P., Larcher, A., Lee, J., ... Autorino, R. (2021). Robotic-assisted Partial Nephrectomy for "Very Small" (<2 cm) Renal Mass: Results of a Multicenter Contemporary Cohort. Eur Urol Focus, 7(5), 1115-1120. https://doi.org/10.1016/j.euf.2020.10.001

Daugherty, M., & Bratslavsky, G. (2014). Compared with radical nephrectomy, nephron-sparing surgery offers a long-term survival advantage in patients between the ages of 20 and 44 years with renal cell carcinomas (=4 cm): an analysis of the SEER database. Urol Oncol, 32(5), 549-554. https://doi.org/10.1016/j.urolonc.2013.11.009

Gill, I. S., Eisenberg, M. S., Aron, M., Berger, A., Ukimura, O., Patil, M. B., ... Desai, M. M. (2011). "Zero ischemia" partial nephrectomy: novel laparoscopic and robotic technique. Eur Urol, 59(1), 128-134. https://doi.org/10.1016/j.eururo.2010.10.002

Kim, S. P., Murad, M. H., Thompson, R. H., Boorjian, S. A., Weight, C. J., Han, L. C., ... Leibovich, B. C. (2012). Comparative Effective¬ness for Survival and Renal Function of Partial and Radical Nephrectomy for Localized Renal Tumors: A Systematic Review and Meta-Ana¬lysis. J Urol. https://doi.org/10.1016/j.juro.2012.10.026

Kutikov, A., & Uzzo, R. G. (2009). The R.E.N.A.L. nephrometry score: a comprehensive stan¬dardized system for quantitating renal tumor size, location and depth. J Urol, 182(3), 844-853. https://doi.org/10.1016/j.juro.2009.05.035

Lee, H. J., Chen, K., Molchanov, R., Schwentner, C., & Sim, A. S. P. (2018). Feasibility of utilizing near-infrared fluorescence imaging with indocyanine green for super-selective arterial clamping in pure laparoscopic partial nephrectomy. Int J Urol, 25(4), 382-383. https://doi.org/10.1111/iju.13525

Li, P., Qin, C., Cao, Q., Li, J., Lv, Q., Meng, X., ... Shao, P. (2016). A retrospective analysis of lapa¬roscopic partial nephrectomy with segmental renal artery clamping and factors that predict postoperative renal function. BJU Int, 118(4), 610-617. https://doi.org/10.1111/bju.13541

Liu, S., Feng, C., Liu, C., & Wang, Z. (2021). Com¬parison of prognosis between patients undergoing radical nephrectomy versus partial nephrectomy for renal cell carcinoma =7 cm T3aN0/xM0: Survival benefit is biased toward partial ne¬phrectomy. Cancer Med, 10(24), 8909-8923. https://doi.org/10.1002/cam4.4412

Ljungberg, B., Albiges, L., Abu-Ghanem, Y., Bedke, J., Capitanio, U., Dabestani, S., ... Bex, A. (2022). European Association of Urology Guidelines on Renal Cell Carcinoma: The 2022 Update. Eur Urol. 82(3), e88. https://doi.org/10.1016/j.eururo.2022.03.006

Motzer, R. J., Jonasch, E., Agarwal, N., Alva, A., Baine, M., Beckermann, K., ... Motter, A. (2022). Kidney Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 20(1), 71-90. https://doi.org/10.6004/jnccn.2022.0001

Pallagani, L., Choudhary, G. R., Himanshu, P., Mad¬duri, V. K. S., Singh, M., Gupta, P., ... Sanjeev, M. (2021). Epidemiology and Clinicopathological Profile of Renal Cell Carcinoma: A Review from Tertiary Care Referral Centre. J Kidney Cancer VHL, 8(1), 1-6. https://doi.org/10.15586/jkcvhl.v8i1.154

Quencer, K. B. (2021). Renal Mass Biopsy. Tech Vasc Interv Radiol, 24(4), 100774. https://doi.org/10.1016/j.tvir.2021.100774

Roussel, E., Capitanio, U., Kutikov, A., Ooster-wijk, E., Pedrosa, I., Rowe, S. P., & Gorin, M. A. (2022). Novel Imaging Methods for Renal Mass Characterization: A Collaborative Review. Eur Urol, 81(5), 476-488. https://doi.org/10.1016/j.eururo.2022.01.040

Saad, A. M., Gad, M. M., Al-Husseini, M. J., Ruhban, I. A., Sonbol, M. B., & Ho, T. H. (2019). Trends in Renal-Cell Carcinoma Incidence and Mortality in the United States in the Last 2 Decades: A SEER-Based Study. Clin Genitourin Cancer, 17(1), 46-57 e45. https://doi.org/10.1016/j.clgc.2018.10.002

Shao, P., Tang, L., Li, P., Xu, Y., Qin, C., Cao, Q., ... Yin, C. (2012). Precise segmental renal artery clam¬ping under the guidance of dual-source computed tomography angiography during laparoscopic partial nephrectomy. Eur Urol, 62(6), 1001-1008. https://doi.org/10.1016/j.eururo.2012.05.056

Thompson, R. H., Lane, B. R., Lohse, C. M., Leibovich, B. C., Fergany, A., Frank, I., ... Campbell, S. C. (2010). Every minute counts when the renal hilum is clamped during partial ne¬phrectomy. Eur Urol, 58(3), 340-345. https://doi.org/10.1016/j.eururo.2010.05.047

Trehan, A. (2014). Comparison of offclamp partial nephrectomy and on-clamp partial nephrectomy: a systematic review and meta-analysis. Urol Int, 93(2), 125-134. https://doi.org/10.1159/000362799

Vaggers, S., Rice, P., Somani, B. K., Veeratterapillay, R., & Rai, B. P. (2021). Evidence-based protocol-led management of renal angiomyolipoma: A review of literature. Turk J Urol, 47(Supp. 1), S9-S18. https://doi.org/10.5152/tud.2020.20343

Van Poppel, H., Da Pozzo, L., Albrecht, W., Matveev, V., Bono, A., Borkowski, A., ... Sylvester, R. (2011). A prospective, randomised EORTC inter¬group phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol, 59(4), 543-552. https://doi.org/10.1016/j.eururo.2010.12.013

Weight, C. J., Larson, B. T., Fergany, A. F., Gao, T., Lane, B. R., Campbell, S. C., . . . Novick, A. C. (2010). Nephrectomy induced chronic renal insuf¬ficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses. J Urol, 183(4), 1317-1323. https://doi.org/10.1016/j.juro.2009.12.030

Xu, J., Xu, S., Yao, B., Xu, R., Xu, Y., Sun, F., ... Shi, H. (2020). Segmental artery clamping versus main renal artery clamping in nephron-sparing surgery: updated meta-analysis. World J Surg Oncol, 18(1), 210. https://doi.org/10.1186/s12957-020-01990-w

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Published

2023-05-19

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Oncourology