Clinical experience of bench surgery combined with autotransplantation after three-dimensional laparoscopic nephrectomy for the treatment of highly complex renal tumor

OBJECTIVE

To assess the feasibility and safety of three-dimensional (3D) laparoscopic nephrectomy in combination with bench surgery and autotransplantation for treating highly complex renal tumors.

MATERIALS AND METHODS

The clinical data of six patients with highly complex renal cell carcinoma were collected. All patients underwent 3D laparoscopic nephrectomy in combination with bench surgery and autotransplantation by the same surgeons, two of them had previously undergone laparoscopic partial nephrectomy for contralateral renal cancer.

RESULTS

The total operative time was 366 ± 65 min, the warm ischemia time (WIT) was 1.3 ± 0.4 min, and the cold ischemia time was 121 ± 26 min. While one patient received a diluted autologous blood transfusion, the intraoperative blood loss was 217 ± 194 ml. No increase in the serum creatinine (SCr) level was observed at postoperative day 30 compared with the preoperative time, and none of the patients received dialysis either during the hospital stay or to date. Although one patient underwent nephrectomy due to tumor recurrence in the transplanted kidney, the others reported no tumor recurrence or distant metastases on imaging to date.

CONCLUSION

3D laparoscopic nephrectomy, when combined with bench surgery and autotransplantation, can become a feasible option for treating highly complex renal cell carcinoma cases when expecting to preserve renal function maximally.

3D-Printed Cold Preservation Device in Renal Autotransplantation for the Treatment of a Patient With Renal Artery Stenosis

Percutaneous transluminal angioplasty (PTRA) is a common treatment method for renal vascular disease (RVD). However, PTRA may not be effective in patients with abnormal vascular disease. Renal autotransplantation (RAT) has been used as an alternative therapy for these diseases. Restrictions due to intracorporeal kidney cold preservation and the renal function of intracorporeal RAT were not as well protected compared with open operation. We developed this technique of 3D-printed polylactide (PLA) cold jackets for laparoscopic complete intracorporeal RAT for the purpose of better protecting the renal function and determining the feasibility of this novel procedure. The procedure was successfully applied to a 51-year-old woman with bilateral renal artery stenosis. The operation time was 5 hours, and blood loss was 200 ml. The patient’s blood pressure remained constant throughout the operation, and the pressure was maintained at 120-140/70–90 mmHg without antihypertensive drugs 1 week after the operation. B-ultrasound showed that the blood flow signal of the transplanted kidney was normal and the boundary between the skin and medulla was clear. The patient was discharged 2 weeks after surgery. One year postoperatively, Doppler ultrasound of the autotransplant showed that the transplanted kidney was normal in size and shape. Radionuclide renal dynamic imaging revealed that the glomerular filtration rate (GFR) of the transplanted kidney was 36.9 ml/min. 3D-printed polylactide (PLA) cold jackets for laparoscopic complete intracorporeal RAT are a safe and effective method for the treatment of renal artery stenosis and represent a feasible method for preserving the renal function of severe renal artery stenosis patients; however, the technology is still at the exploratory stage and has room for further improvements.

Ex vivo nephron-sparing surgery and kidney autotransplantation for renal tumors

The nephron-sparing techniques allow the excision of kidney tumors preserving renal function and ensuring adequate oncological results. We describe a case of a 77-year-old patient who underwent an ex vivo partial nephrectomy with orthotopic autotransplantation for kidney cancer. The postoperative course was marked by bleeding which required radiological embolization. Postoperative dialysis was required for about 1 month. The anatomopathological examination showed a clear cell carcinoma staged pT1b, pNX, R0. At 2 years follow-up, no recurrence was detected with a complete renal function restoration. Our experience shows that ex vivo nephron-sparing surgery with autotransplantation is a good alternative to total nephrectomy in the case of voluminous or perihilar tumors. Considering the high morbidity of this procedure, it should be only performed in specialized centers.

The efficacy and safety of microwave ablation in patients with retroperitoneal metastases

BACKGROUND

Retroperitoneal metastases are common, and most present with symptoms; however, treatments for this condition are limited. This retrospective study verified the efficacy and safety of microwave ablation (MWA) in retroperitoneal metastases patients.

METHODS

Patients with pathologically confirmed malignant carcinoma and imaging showing retroperitoneal metastases were enrolled and underwent MWA. The end-points included objective response rate, time to local progression (TTLP), overall survival, visual analogue scale (VAS) score, dose of morphine pre- and post-ablation and complications.

RESULTS

Twenty-three patients were enrolled. The mean tumour diameter was 3.6 cm. Altogether, 29 tumour sites in 23 patients were ablated during 23 procedures; technical success was achieved in all 23 patients. The objective response and disease control rates were 95.7% and 100.0%, respectively. The mean TTLP and median OS were 22.8 months (95% CI: 16.1-29.6 months) and 10.6 months (95% CI: 7.4-13.8 months), respectively. In 13 patients with symptoms, the VAS values before ablation and 48 h, 1 month, 2 months, 3 months and 6 months after ablation were 5.38, 2.77 (p = 0.015), 2.15 (p = 0.001), 2.17 (p = 0.001), 1.40 (p = 0.000) and 1.71 (p = 0.006), respectively. The corresponding morphine doses were 76.9 mg, 70.7 mg (p = 0.584), 50.7 mg (p = 0.031), 55.0 mg (p = 0.097), 46.0 mg (p = 0.057) and 40.0 mg (p = 0.363), respectively. No ablation-associated mortality was observed. Major complications, minor complications and adverse events were observed in eight (34.8%), five (21.7%) and four (17.4%) patients, respectively.

CONCLUSION

MWA for the treatment of retroperitoneal metastases was effective and the complications were common.