Minimally invasive technologies for surgical treatment of kidney cancer

Abstract

The OBJECTIVE was to analyze the developmental trends, possibilities and outcomes of applying minimally invasive technologies in surgical treatment for kidney cancer.METHODS AnD MATERIALS. The study included 368 surgeries for kidney tumors which were performed from 2012 to 2019. Partial nephrectomy (Pn) was performed in 228 (60.6 %) cases, radical nephrectomy (Rn) – in 148 (39.4 %) cases. Tumors of the stage cT1a detected in 148 (39.4 %), сТ1b – 145 (38.6 %), сT2a – 58 (15.4 %), сТ2b-cTxn1M1 – 25 (6.7 %) patients. Operations were performed using open (3.7 %), laparoscopic (50.3 %), robotic (46.0 %) approaches with assessment of surgical and oncological outcomes of treatment.RESULTS. The incidence rate of Pn in patients with kidney cancer at the stages cT1a, cT1b and cT2a was 89.9, 57.2 and 20.7 %. Rn was performed in all cases of tumor stage сТ2b-cTxn1M1. The frequency of Pn at the stages cT1a, cT1b and cT2a in 2019 exceeded 80 %. Minimally invasive technologies (MIT) for Pn was used in 98.3 %, for Rn – in 92.2 % of cases. The incidence rate of postoperative complications after Pn and Rn at stages сТ1а, сT1b, сТ2а was 14.3and 6.7, 16.9 and 3.2, 16.7 and 2.2 %, respectively. Complications after Rn at tumors of the stage cT2bcTxn1M1 occurred in 20.0 % of patients. Positive surgical margin (PSM) occurred after Pn for tumors of the stage cT1a in 0.7 % of cases; for cT1b – in 2.4 %; for cT2a and after Rn – was not determined.CONCLUSION. Our study demonstrates a steady tendency towards an increase in the number of MIT for kidney tumors, including when performing organ-preserving surgeries. Robot-assisted surgery allows to expand the indications to use a minimally MIT even in the most difficult clinical cases. The frequency of complications after RP compared with Rn is higher because the complexity of the operation increases, and these complications did not affect the outcome of treatment, taking into account the functional advantages provided for patients. The development and widespread introduction of minimally MIT into clinical practice is an evident and inevitable way to develop surgical treatment of kidney cancer.