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Partial nephrectomy with perfusion cooling for imperative indications: a 24-year experience.
Joachim Steffens1, Ulrich Humke, Manfred Ziegler
1Department of Urology and Paediatric Urology, St. Antonius-Hospital Eschweiler, Homburg/Saar, Germany. jsteffans.sah-eschweiler@clinet.de
BJU International
|August 18, 2005
Summary
Open partial nephrectomy using cold perfusion for imperative indications offers excellent tumor control and preserves kidney function, avoiding dialysis in most patients. This technique provides a bloodless field for complex renal tumor resections.
Area of Science:
- Urology
- Surgical Oncology
- Nephrology
Background:
- Partial nephrectomy is challenging for imperative indications.
- Cold ischemia via renal artery perfusion offers a solution for complex cases.
Purpose of the Study:
- To report a 24-year experience with open partial nephrectomy using cold ischemia.
- To evaluate the technique's safety, efficacy, and long-term outcomes.
Main Methods:
- Open partial nephrectomy performed on 65 patients with imperative indications (solitary kidney, bilateral tumors, or renal failure).
- Cold ischemia induced by continuous renal artery perfusion with Ringer's lactate at 4°C.
- Tumor resection in a bloodless field with tumor bed biopsies.
Main Results:
- Mean operative time: 132 min; mean ischemia time: 49 min.
- Complications included hemorrhage (19%), urinary fistula (8%), and acute renal failure (6%).
- No perfusion-related complications (e.g., artery stenosis/thrombosis).
- Stable creatinine levels post-surgery, no long-term dialysis needed.
- Tumor-specific survival: 94% (1 yr), 76% (5 yr), 76% (10 yr).
Conclusions:
- Cold ischemia via renal artery perfusion is effective for selected renal tumors with imperative indications.
- Provides excellent visibility and allows unhurried resection, negating ex vivo surgery.
- Achieves good long-term tumor control and preserves renal function, preventing dialysis dependency.