Number Т. 9, № 4 (36) 2019

The first experience of using super-selective X-ray vascular embolization and intraoperative fluorescence imaging in the surgical treatment of localized kidney cancer

Dumanskiy Yu.V. 1, Diachenko A.M.2, Reshetniak S.A.2, Freigofer M.V.2

Summary. The incidence of local cancer of the kidney is from 40 to 60% in comparison with the total number of newly diagnosed kidney cancer. The tactics of surgical treatment for local cancer of the kidney, the access method, the need for heat ischemia during resection, despite extensive international experience, remain completely undefined. The use of modern diagnostic methods — computed tomography, preoperative angiography — play a key role in accurately determining the location of the tumor in the kidney, studying the architecture of the kidney vessels, which allows you to perform a functionally sparing operation. Objective. Optimize surgical treatment of patients with localized kidney cancer by using superselective X-ray vascular embolization and intraoperative fluorescence imaging in the infrared spectral mode using Indocyanine green at the preoperative stage. Маterials and methods. Two patients with localized kidney cancer. The algorithm and treatment were as follows: in all cases, kidney tumors were identified by chance during prophylactic ultrasound diagnostics. Subsequently, patients underwent computed tomography with intravenous amplification to study the architectonics of the renal vessels during the arterial phase and the determination of the renal vessels that were to be embolized. As the next step in treatment of patients, retroperitoneoscopic resection of the lower pole of the kidney (ZERO ishemia) was carried out to determine the boundaries of the resection using intraoperative fluorescence imaging in the infrared spectrum using indocyanin green (Indocyanine green). Results. 2 patients with local renal cell carcinoma performed retroperitoneoscopic resection of the kidney (ZERO ishemia) using intraoperative fluorescence imaging in mode of the infrared region of the spectrum using indocyanin green. In the preoperative stage, patients underwent superselective radiovascular embolization. During surgery and the early postoperative period of complications not registered. The operation time was in the first case of 74 min, in the second — 68 min. The level of intraoperative blood loss in both cases was about 50 ml. Hospital stay is 3 days. In both cases at morphological study in patients morphologically verified clear cell renal cell carcinoma (pT1cN0M0R0G2). Conclusions. According to preliminary data, the use of super-selective X-ray vascular embolization and intraoperative fluorescence imaging in the surgical treatment of localized kidney cancer in comparison with the standard method of surgical treatment has advantages.
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