ZIRK-Technique: Zero Ischemia Resection in the Kidney for High-Risk Renal Masses: Perioperative Outcome

The effect of 11th rib excision on perioperative outcomes in patients undergoing partial nephrectomy for upper pole renal tumors

INTRODUCTION

We aimed to evaluate the effect of eleven11th rib resection.on the perioperative period TRIFECTA criteria in patients who underwent retroperitoneal partial nephrectomy (PN) with the diagnosis of upper pole kidney tumors.

MATERIALS AND METHODS

We conducted a retrospective analysis of the data of the patients who underwent Open PN for upper pole renal masses between 2018 and 2023. The patients were divided into two groups: PN with rib resection and PN without rib resection. The demographic characteristics, tumor sizes, PADUA scores, warm-cold renal ischemia times, mass excision and tumor bed suturing times, histopathological tumor type and surgical margin positivity of the patients were examined. Both groups were evaluated comparatively based on this data.

RESULTS

The renal nephrometry scores of the two groups were similar. The total renal ischemia time was significantly shorter in the patients who underwent a rib resection than in those who did not (p < 0.001). Both the tumor excision and tumor bed suturing times were significantly shorter in the group that underwent a rib resection than in the group that did not (p < 0.001). The Clavien-Dindo complication grades were statistically similar between the two groups.

CONCLUSION

Complex in nature and high-risk renal masses located in the upper pole of the kidney, partial nephrectomy performed with an 11th rib resection can be considered a reliable surgical option with a shorter ischemia time, supporting the preservation of long-term renal function.

Open Partial Nephrectomy with Zero Ischaemia Using a Supra 12th Rib Miniflank Incision: A Minimally Invasive Open Approach for Small Renal Masses

Introduction

To assess a minimally invasive open technique for partial nephrectomy with zero ischaemia time.

Methods

A review was performed in a prospectively maintained database of a single surgeon series of all patients undergoing partial nephrectomy using a supra 12^th rib miniflank incision with zero ischaemia. Data of seventy one patients who underwent a partial nephrectomy over an 82-month period were analyzed. Data analyzed included operative time, estimated blood loss, pre and postoperative renal function, complications, final pathological characteristics, and tumour size.

Results

Seventy one partial nephrectomies were performed from February 2009 to October 2015. None were converted to radical nephrectomy. Mean operative time was 72 minutes (range 30–250), and mean estimated blood loss was 608 mls (range 100–2500) with one patient receiving blood transfusion. The mean pre and postoperative haemoglobin levels were 144 and 112 g/l. The mean pre and postoperative creatinine levels were 82 and 103 Umol/L. There were 8 Clavian–Dindo Grade 2 complications and 1 major complication (Clavian IIIa). Histology confirmed 24 benign lesions and 47 malignant lesions, 46 cT1a lesions, 24 cT1b lesions, and 1 cT2 lesion. Median follow-up was 38 months with no local recurrence or progression of disease with 5 patients having a positive margin (7%).

Conclusion

Our results demonstrate that a supra 12th miniflank incision open partial nephrectomy with zero ischaemic time for SRMs has satisfactory outcomes with preservation of renal function. A minimally invasive open partial nephrectomy remains an important option for units that cannot offer patients a laparoscopic or a robotic procedure.

Comparison of selective and main renal artery clamping in partial nephrectomy of renal cell cancer: A PRISMA-compliant systematic review and meta-analysis

BACKGROUND

The aim of the present study was to perform a systematic review and meta-analysis of the studies comparing the efficiency and safety of selective renal artery clamping (SAC) and main renal artery clamping (MAC) in partial nephrectomy (PN) for renal cell cancer (RCC).

METHODS

According to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement, a literature search on PubMed, EMBASE, Web of Science, and Chinese National Knowledge Infrastructure were conducted to identify relevant studies published through December 2017. Outcomes of interest included baseline characteristics and perioperative surgical variables.

RESULTS

In all, 14 studies involving 2824 RCC patients comparing SAC and MAC were included in this meta-analysis. No differences were detected in mean patient body mass index (P = .08), tumor size (P = .22), baseline estimated glomerular filtration rate (eGFR) (P = .60), American Society of Anesthesiologists score (P = .97), or RENAL score (P = .70). The mean age was significantly younger in the SAC group compared with the MAC group (P = .002). There was no difference between SAC and MAC groups in terms of warm ischemia time (P = .31), transfusion rate (P = .18), length of hospital stay (P = .47), or postoperative complication rate (P = .23). Although SAC had longer operating time (OT) (P = .04) and more estimated blood loss (EBL) (P = .0002), a lower percentage decrease in eGFR in the SAC group was found compared to the MAC group (P = .002).

CONCLUSIONS

Patients undergoing PN with SAC had longer OT and higher EBL. SAC was more frequently used in younger patient. SAC offered better renal function preservation when compared with MAC for RCC. Given the inherent limitations of the included studies, further well-designed randomized controlled trials are required to verify these findings.

Open Partial Nephrectomy for High-Risk Renal Masses Is Associated with Renal Pseudoaneurysms: Assessment of a Severe Procedure-Related Complication

Objectives. A symptomatic renal pseudoaneurysm (RPA) is a severe complication after open partial nephrectomy (OPN). The aim of our study was to assess incidence and risk factors for RPA formation. Furthermore, we present our management strategy. Patients and Methods. Clinical records of consecutive patients undergoing OPN were assessed for surgical outcome and postoperative complications. Renal masses were risk stratified for tumor complexity according to the PADUA score. Uni- and multivariate analysis for symptomatic RPAs were performed using the t-tests and logistic regression. Results. We identified 233 patients treated with OPN. Symptomatic RPAs were observed in 13 (5.6%) patients, on average 14 (4–42) days after surgery. Uni- and multivariate analysis identified tumor complexity to be an independent predictor for symptomatic RPAs (p = 0.004). There was a significant correlation between RPAs and transfusion and the duration of stay (p < 0.001 and p = 0.021). Symptomatic RPAs were diagnosed with CT scans and successfully treated with arterial embolization. Discussion. Symptomatic RPAs are not uncommon after OPN for high-risk renal masses. A high nephrometry score is a predictor for this severe complication and may enable a risk-stratified followup. RPAs can successfully be located by CT angiography, which enables targeted angiographic treatment.