Abstract
BackgroundRecently studies have demonstrated improved outcomes in patients undergoing nephron-sparing surgery (NSS) for low stage renal tumors, thus NSS is widely accepted as the treatment option for these patients. With NSS, there is a risk of renal hemorrhage and thus haemostatic agents may be routinely applied to the cut surface of the kidney. Herein we compare two commercially available haemostatic agents applied intra-operatively to the cut surface of the kidney. Post-operative outcomes (oncologic and non-oncologic) are reported.MethodsThe medical records of 23 patients with suspicious renal mass documented on axial imaging and who underwent open NSS via a mini-subcostal incision were extensively reviewed. One of two haemostatic agents (Floseal®, n = 11; Arista®, n = 12) was intra-operatively applied to the cut surface of the kidney. Chi-square and T- student test was used to compare outcomes between the cohort of 11 patients who had Floseal® and the 12 patients who had Arista®.ResultsMedian pre-operative size of renal mass was 4.3 cm (range 1.5-7.0 cm). Final pathology revealed 3 oncocytomas and 20 renal cell carcinoma (17 clear cell, 1 chromophobe and 2 papillary), pT1a = 14 and pT1b = 6. Mean intra-operative blood loss and hospital stay between the Floseal®vs. Arista® cohorts did not significantly differ (227 mL vs. 250 mL, p = 0.68 and 4.4 days vs. 4.5 days, p = 0.76, respectively). Intra-operative and post-operative complications were not different between the two cohorts. No recurrences have been documented with a mean follow-up of 18 months.ConclusionAlong with meticulous surgical technique, the use of either haemostatic agent (Floseal® or Arista®) was not associated with high rate of intra-operative or post-operative haemorrhage. Thus either haemostatic agent may be successfully used during NSS.
Highlights
Studies have demonstrated improved outcomes in patients undergoing nephron-sparing surgery (NSS) for low stage renal tumors, NSS is widely accepted as the treatment option for these patients
Renal cell carcinoma (RCC) accounts for over 85% of all kidney tumors, which makes up 2-3% of all adult malignancies [3]
Median pre-operative size of renal mass measured on axial imaging was 4.3 cm
Summary
Studies have demonstrated improved outcomes in patients undergoing nephron-sparing surgery (NSS) for low stage renal tumors, NSS is widely accepted as the treatment option for these patients. With NSS, there is a risk of renal hemorrhage and haemostatic agents may be routinely applied to the cut surface of the kidney. We compare two commercially available haemostatic agents applied intra-operatively to the cut surface of the kidney. Studies have demonstrated improved non-oncological outcomes in patients undergoing NSS for low-stage tumors [10]. We currently find ourselves in the midst of a new era in the management of low-stage kidney cancer, where NSS is center stage and widely accepted as the treatment option for these patients
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