Modern ideas about the methods of surgical organ-preserving treatment of kidney cancer

Abstract

Renal cell carcinomas account for about 3% of all cancers in adults. The annual increase in the detection of this disease is 2,9%, which is due both to a true increase in the number of cases and to the widespread introduction of modern research methods (ultrasounds examination, computerized tomography, magnetic resonance imaging) that allow us to detect small asymptomatic lesions. This, in turn, makes it possible to perform organ-preserving surgical interventions. Comparative analysis of long-term results of treatment in patients after kidney resection does not differ from those after radical nephrectomy, at the same time, the functional results of organ-preserving surgical interventions are more attractive, especially in patients with an initially present renal dysfunction. Currently, there are three methods of performing organ-preserving operations: open, laparoscopic and robot-assisted kidney resection. Contrary to the general interest in the problem of nephron-preserving surgery of renal cell carcinomas, the choice of operative access while performing kidney resection remains the subject of discussion. In this light, the use of intermuscular mini-lumbotomy access can act as an optimal replacement for laparoscopic access or resection from traditional lumbotomy. This technique of operative intervention allows to combine the positive properties of both minimally invasive procedure (laparoscopic resection) and open surgical intervention: reduction of the volume of blood loss and duration of the operation, reduction of hospitalization time, fewer late complications, good cosmetic result. Also, the issues of processing the resected surface of the organ, the time of ischemia, and the choice of the vascular clamp when clamping the renal artery, the distance from the tumor edge to the line of resection are also disputable. In addition, the functional results of organ-preserving resections of the kidney are not sufficiently studied in the long term after surgical interventions.