Benefits and shortcomings of superselective transarterial embolization of renal tumors before zero ischemia laparoscopic partial nephrectomy |
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| Affiliation: | 1. “San Giovanni Bosco” Hospital, Department of Urology, Turin, Italy;2. University Campus Biomedico, School of Medicine, Rome, Italy;3. “San Giovanni Bosco” Hospital, Department of Radiology, Turin, Italy;1. Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Digestive Disease, Karolinska University Hospital, Solna, P9:03, 17176 Stockholm, Sweden;2. Karolinska Institutet (KI), Department of Oncology-Pathology (OnkPat) K7, Z4:01, Karolinska University Hospital, 17176 Stockholm, Sweden;3. Department of Radiology, Oncology and Radiation Science, Uppsala University, Akademiska sjukhuset, 75185 Uppsala, Sweden;1. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA;2. Department of Urology, University Hospital Basel, Basel, Switzerland;3. Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France;4. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;5. Department of Urology, AP-HP, Hopital Pitié-Salpétrière, Service d''Urologie, Paris, France;6. UPMC Univ. Paris 06, GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie, Paris, France;7. Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women''s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA;8. Department of Urology, Medical University of Vienna, Vienna, Austria;9. Department of Surgical, Oncological and Gastroenterologic Sciences, Urology Clinic, University of Padua, Italy;10. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA;11. Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain;12. Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan;13. Department of Urology, Landesklinikum Korneuburg, Korneuburg, Austria;14. Department of Urology, University of Montreal, Montreal, QC, Canada;15. Department of Urology, Vita-Salute University, Milan, Italy;1. Department of Gastric Surgery, Liaoning Cancer Hospital & Institute, Shenyang, People''s Republic of China;2. Department of Radiology, Liaoning Cancer Hospital & Institute, Shenyang, People''s Republic of China;3. Center of Tumor Diagnosis and Therapy, The Second Workers Hospital of Liaohe Oil Field, Panjin, People''s Republic of China;1. Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, United Kingdom;2. Altnagelvin Area Hospital, Derry BT47 6SB, Northern Ireland, United Kingdom;3. Liverpool Hepatobiliary Centre, University Hospital Aintree, Liverpool L9 7AL, United Kingdom;1. Department of Surgery, Sungkyunkwan University School of Medicine, South Korea;2. Center for Clinical Trial, National Cancer Center, South Korea;3. Center for Gastric Cancer, National Cancer Center, South Korea;4. Department of Surgery, Chonnam National University Hwasoon Hospital, South Korea |
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| Abstract: | AimsTo report feasibility, safety and effectiveness of “zero-ischemia” laparoscopic partial nephrectomy (LPN) following preoperative superselective transarterial embolization (STE) for clinical T1 renal tumors.MethodsWe retrospectively reviewed perioperative data of 23 consecutive patients, who underwent STE prior LPN between March 2010 and November 2012 for incidental clinical T1 renal mass. STE was performed by two experienced radiologists the day before surgery. Surgical procedures were performed in extended flank position, transperitoneally, by a single surgeon.ResultsMean patients age was 68 years (range 56–74), mean tumor size was 3.5 cm (range 2.2–6.3 cm). STE was successfully completed in 16 patients 12–15 h before surgery. In 4 cases STE failed to provide a complete occlusion of all feeding arteries, while in 3 cases the ischemic area was larger than expected.LPN was successfully completed in all patients but one where open conversion was necessary; a “zero-ischemia” approach was performed in 19/23 patients (82.6%) while hilar clamp was necessary in 4 cases, with a mean warm-ischemia time of 14.8 min (range 5–22).Mean operative time was 123 min (range 115–130) and mean intraoperative blood loss was 250 mL (range 20–450).No patient experienced postoperative acute renal failure and no patient developed new onset IV stage chronic kidney disease at 1-yr follow-up.ConclusionsSTE is a viable option to perform “zero-ischemia” LPN at beginning of learning curve; however, hilar clamp was necessary to achieve a relatively blood-less field in 17.4% of cases. |
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| Keywords: | Embolization Kidney neoplasm Laparoscopic partial nephrectomy Off-clamp Zero ischemia |
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