Partial nephrectomy with perfusion cooling for imperative indications: a 24‐year experience

• Published in: BJU international 2005-09, Vol.96 (4), p.608-611
• Main Authors: Steffens, Joachim, Humke, Ulrich, Ziegler, Manfred, Siemer, Stefan
• Format: Article
• Language: English
• Subjects: artery perfusion; Biological and medical sciences; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - surgery; Cold Temperature; Constriction; Female; Follow-Up Studies; Humans; ischaemia; Ischemia; Kidney - abnormalities; Kidney Neoplasms - mortality; Kidney Neoplasms - surgery; Kidneys; Male; Medical sciences; Neoplasm Staging; Neoplasms, Multiple Primary - mortality; Neoplasms, Multiple Primary - surgery; Nephrectomy - methods; Nephrectomy - mortality; Nephrology. Urinary tract diseases; partial nephrectomy; Perfusion; Postoperative Care; Renal Artery; renal cell carcinoma; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival Rate; Tumors of the urinary system; venotomy
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2005.05693.x

OBJECTIVE To report our 24‐year experience with open nephron‐sparing surgery for renal tumours, using cold ischaemia achieved by renal artery perfusion, as partial nephrectomy for imperative indications is a surgical challenge. PATIENTS AND METHODS From 1980 to 2004, open partial nephrectomy was performed in 717 patients; of these, 65 (9.1%) with a solitary kidney, synchronous bilateral tumours or renal failure in the opposite kidney (imperative indication) had surgery under cold ischaemia, achieved by continuous perfusion of Ringer's lactate at 4 °C through the renal artery, which was clamped and cannulated. The tumour was resected in a bloodless field, with biopsies taken from the tumour bed. Focusing on patients with an imperative indication and cold perfusion, we report our perfusion technique, and the ischaemia time, complication rate and cancer‐specific survival rate of these patients. RESULTS The mean (sd, range) operative duration was 132 (103, 91–252) min and ischaemia time 49 (37, 31–71) min. The most common complications were postoperative haemorrhage in 19%, urinary fistula in 8% and acute renal failure in 6% of patients. There were no specific complications related to the perfusion technique (renal artery stenosis, renal artery or vein thrombosis). The mean (sd, range) long‐term follow‐up of 95 (71, 4.3–231) months showed increased but constant creatinine values (95 µmol/L before, 182 µmol/L after surgery; P