Complex renal tumors on solitary kidney: results of ex vivo nephron-sparing surgery with autotransplantation

摘要

OBJECTIVE: To analyze the complications and the oncologic and functional results after ex vivo surgery and autotransplantation for the treatment of complex renal tumors. MATERIAL AND METHOD: From 1996 to 2009, 11 patients, mean age 54.8 years, underwent ex vivo nephron-sparing surgery and autotransplantation for malignant complex renal tumors (centrorenal or hilar topography) on an anatomic or functional solitary kidney. Three patients (27.2 %) were treated for a metastatic disease. RESULTS: Mean operative time was 340 minutes (240-440) and mean ischemia time was 162 minutes (110-231). Five patients (45.4 %) needed peroperative blood transfusion. Mean hospital stay was 21.5 days (8-50). Eight patients (72.7 %) suffered complications: two urinary fistulas, two early vascular thrombosis leading to nephrectomy and permanent dialysis, two pneumopathies and four acute tubular necrosis leading to temporary dialysis. There was no death among patients in early postoperative period. Tumors TNM staging ranged from pT1 to pT3aN0. Surgical positive margins were observed in three cases (27.2 %). With a mean follow-up of 37.8 months (3-144), the mean MDRD creatinine clearance was of 45.4 ml/min/1.73 m(2) and four patients (36.4 %) were presenting a complete remission. We observed two local recurrences (18.2 %) and five metastatic evolutions (45.4 %) leading to two deaths (18.2 %). CONCLUSION: Ex vivo nephron-sparing surgery was an acceptable option in the treatment of complex renal tumors for imperative indications, when in situ surgery appeared to be technically unfeasible. Despite a significative morbidity, long-term functional results were satisfying.