Renal function after laparoscopic partial nephrectomy with superselective balloon embolization of renal artery
Objective: To evaluate the functional state of the renal parenchyma after partial nephrectomy, depending on surgical technique.
Methods: The study comprised 21 patients with kidney neoplasms of stage T1-2N0M0. The patients underwent either laparoscopic partial nephrectomy with superselective balloon embolization of the renal artery (study group, n=11), or partial nephrectomy with vascular clamping (control group, n=10). The mean age of the patients in the study group (3 men and 8 women) was 56.8 years. The tumor was located in the right kidney in 5 patients and in the left kidney in 6 patients. The size of the neoplasm ranged from 0.9 to 3.8 cm, averaging 1.9 cm. The complexity of the surgery was evaluated using R.E.N.A.L. Nephrometry Scoring System based on MSCT findings. The mean nephrometry score was 5.1, which corresponds to low complexity of the intervention. Patients of the control group underwent partial nephrectomy with vascular clamping and renal ischemia time of no more than 20 minutes. The mean age of the control group patients was 57.3 years. The tumor was located in the right kidney in 4 patients and in the left kidney in 6 patients. The tumor size ranged from 1 to 4.1 cm, averaging 2.2 cm. The mean nephrometry score based on MSCT findings was 6.1. In both groups, the difference in creatinine clearance between the operated and intact kidney was estimated before the operation and in the early postoperative period to assess the changes in glomerular filtration.
Conclusions: The level of serum creatinine remained within the normal range throughout the study period in both groups. In the postoperative period, the creatinine clearance of the operated kidneys showed 1.02-fold decrease after super selective embolization and 1.92-fold decrease after vascular clamping. The 1-minute diuresis of the operated kidney decreased by 83.21% and 43.53% after vascular clamping and embolization, respectively. Conclusions: The studys findings show there was no significant dysfunction of operated kidneys after superselective balloon embolization of the renal artery.