scholarly journals Laparoscopic removal of a kidney tumor after superselective embolization of the kidney vessels

2020 ◽  
Vol 21 (1) ◽  
pp. 65-69
Author(s):  
V. V. Zemlyansky ◽  
O. B. Zhukov ◽  
T. A. Kurmanov ◽  
Zh. D. Zhumagazin ◽  
A. M. Chinaliev
Keyword(s):  
Blood Loss ◽  
Tumor Resection ◽  
Tumor Diameter ◽  
Kidney Tumor ◽  
Feeding Artery ◽  
Loss Of Function ◽  
Kidney Tumors ◽  
Study Objective ◽  
Superselective Embolization ◽  
Kidney Resection

The study objective is to evaluate the effectiveness of using superselective embolization of the renal arterial bed prior to organ-preserving laparoscopic kidney tumor resection.Materials and methods. At the Center for Urology, Kidney Transplantation and Nephrology of the National Research Oncology Center (Nur-Sultan, Kazakhstan) between 2015 and 2019 laparoscopic kidney tumor resection was performed in 45 patients; in 9 patients with stage T1 kidney tumors, superselective embolization was also performed. Mean age of the patients was 54 years, mean tumor diameter was 2.8 cm. Localization near the kidney pole and presence of an artery isolatedly supplying the tumor were the main indications for superselective embolization of the feeding artery prior to kidney resection.Results. Mean blood loss was 280 ml. Complications characteristic of post-embolization period (pain, fever, arterial hypertension), as well as loss of function of the organ, were absent 3, 6 and 12 months after the procedure per laboratory and radiological examinations.Conclusion. Superselective embolization of the tumor feeding artery is an effective method allowing to minimize warm ischemia of the renal parenchyma and perform kidney resection with minimal blood loss.The authors declare no conflict of interest.All patients gave written informed consent to participate in the study and to the publication of their data.

scholarly journals Preoperative Embolization of Brain Tumor with Pial Artery or Dural Branch of Internal Carotid Artery as Feeding Artery

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 246-251 ◽  
Author(s):  
M Hirohata ◽  
T Abe ◽  
N Fujimura ◽  
Y Takeuchi ◽  
M Shigemori
Keyword(s):  
Brain Tumor ◽  
Carotid Artery ◽  
Blood Loss ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Tumor Resection ◽  
Preoperative Embolization ◽  
Digital Subtraction ◽  
Feeding Artery ◽  
Pial Artery

This study evaluated the clinical usefulness of preoperative embolization of the pial artery or dural branch of the internal carotid artery (ICA) for brain tumor. Subjects comprised 17 patients with large hypervascular brain tumors who underwent preoperative selective embolization. Micro-catheters (2- or 1.7-F) and shapeable hydrophilic micro-guide wires were used for pial artery (branching from the posterior or anterior cerebral artery) or ICA dural branch embolization. Embolization was performed under digital subtraction fluoroscopy with Polyvinyl alcohol (PVA) particles (150–250 mm) and/or liquid coil. Tumor resection was performed immediately or the day after embolization. Digital subtraction angiography (DSA) before and after endovascular devascularization, blood loss during tumor resection, and clinical outcome were evaluated. All endovascular procedures were technically successful. Post-embolization DSA revealed either a disappearance or a marked decrease of the tumor stain in all cases. Control of intraoperative bleeding was easily accomplished, and intraoperative blood loss was low. Preoperative particle embolization of the feeding artery from the cortical artery or ICA dural branch is safe and effective as adjuvant therapy before tumor resection.

Experience of performing laparoscopic organ-preserving operations in treatment of kidney tumors

2020 ◽  
pp. 11-18
Author(s):  
N. V. Kovalenko ◽  
V. V. Javoronkova ◽  
A. I. Ivanov ◽  
A. G. Chuhnin ◽  
V. B. Venskel ◽  
...  
Keyword(s):  
Blood Loss ◽  
Average Duration ◽  
Operation Time ◽  
Malignant Neoplasms ◽  
Intraoperative Blood Loss ◽  
Kidney Tumors ◽  
Results Of Treatment ◽  
Duration Of Surgery ◽  
Direct Results ◽  
Kidney Resection

Purpose: to conduct a comparative assessment of the effectiveness and safety of laparoscopic kidney resections for benign and malignant neoplasms with and without vascular isolation of the organ. Materials and methods: the research presents a comparative analysis of the direct results of treatment of 182 patients who underwent laparoscopic kidney resection. Among them there were 94 men (51,7 %) and 88 women (48,3 %). The average age was 61,6 ± 6,2 years. Two main methods were used: kidney resection with vascular isolation and without vascular ischemia. Surgical treatment was performed for malignant neoplasms in 152 cases (86,5 %) and for benign neoplasms in 24 cases (13,6 %). We used the methods of laparoscopic resection of the kidney with total vascular ischemia in 44 cases (24,2 %) and without vascular ischemia in 138 patients (75,8 %). Results: the average duration of surgery was 80 ± 18,5 minutes. The average duration of the operation with the use of vascular ischemia was 122,1 ± 17,5 minutes, without ischemia — 81,7 ± 10,6 minutes. The volume of intraoperative blood loss averaged 174,4 ± 20,1 ml, while this indicator when using the ischemic-free technique was 154,2 ± 15,7 ml, which is 32,9 % less (p> 0,05) than in cases with the use of vascular isolation (230,1 ± 20,8 ml). When using the technique of vascular isolation, the serum creatinine has increased for 16,2 ± 1,7 μmol / L (16,7 %), without vascular isolation 6,5 ± 1,5 μmol / L (6,7 %). Conclusion: laparoscopic kidney resections without vascular isolation are characterized by a lower volume of intraoperative blood loss, a shorter operation time and are not accompanied by an increase in the number of postoperative complications.

scholarly journals First experience of superselective embolization of renal arteries supplying the tumor with subsequent laparoscopic kidney resection

2021 ◽  
Vol 17 (3) ◽  
pp. 30-36
Author(s):  
V. L. Astashov ◽  
V. V. Shapovalov ◽  
V. V. Balanyuk ◽  
A. I. Zagorul’ho ◽  
D. V. Kozlov ◽  
...  
Keyword(s):  
Blood Loss ◽  
Renal Artery ◽  
Kidney Cancer ◽  
Renal Tumors ◽  
Two Stage ◽  
Second Stage ◽  
Superselective Embolization ◽  
Single Kidney ◽  
Functioning Kidney ◽  
Kidney Resection

Background. Patients with signs of tumor lesions in a single kidney or in the only one functioning kidney, with bilateral renal tumors are at high risk of functional failure or insufficiency of the kidney after surgery. Joint discussions with specialists in X-ray endovascular surgeries resulted in the development of a treatment algorithm for patients with localized kidney cancer who require organ-sparing surgery without ischemic kidney resection.Objective: to evaluation of the immediate results of two-stage surgical treatment of localized kidney cancer in patients with signs of tumor lesions in a single kidney or in the only one functioning kidney, with bilateral renal tumors, including superselective embolization of the artery supplying the tumor at the first stage, and laparoscopic kidney resection without renal ischemia parenchyma at the second stage.Materials and methods. This study included 5 patients with localized kidney cancer, who underwent two-stage treatment at Moscow Regional Oncology Dispensary between 24.03.2021 and 19.04.2021. The first stage included superselective embolization of the artery supplying the tumor; the second stage implied laparoscopic kidney resection 6-7 days following the first stage.Results. The median age of the patients was 62 years (range: 42-73 years). Four patients (80%) had unilateral kidney lesions, while 1 patient (20 %) had bilateral (synchronous) kidney cancer. The mean RENAL score was 8 (range: 6-10); patients were distributed as follows: score 4-6 in 40 %, score 7-9 in 40 %, and score >10 in 20 % of patients. At the first stage, patients underwent endovascular embolization of the branches of the renal artery. Patients had superselective embolization of either middle (n = 3; 60 %), upper (n = 1; 20 %), or lower (n = 1; 20 %) segmental arteries supplying the tumor. In one of them (20 %), we identified 3 large arterial branches; in another one (20 %), we identified 2 large arterial branches.At the second stage, we performed laparoscopic kidney resection. None of the patients required renal artery clamping, because there was an excellent visualization of the demarcation zone and no significant blood loss. The resection area was sutured in 1 case (20 %). In 2 individuals (40 %), a hemostatic sponge was installed in the removed tumor bed. In the remaining 2 cases (40 %), hemostasis was ensured by coagulation. The median blood loss was 100 mL (range: 50-200 mL). The postoperative period was uneventful in all patients. None of the patients developed symptoms of acute renal failure.Conclusion. Thus, superselective embolization of arteries supplying a kidney tumor has undeniable advantages in organ-sparing surgeries for patients with localized kidney cancer and some additional kidney problems, when organ preservation is crucial for patient's life.

Preoperative Embolization of Brain Tumor with Pial Artery or Dural Branch of Internal Carotid Artery as Feeding Artery

1995 ◽  
Vol 8 (6) ◽  
pp. 246-251
Author(s):  
M Hirohata ◽  
T Abe ◽  
N Fujimura ◽  
Y Takeuchi ◽  
M Shigemori
Keyword(s):  
Brain Tumor ◽  
Carotid Artery ◽  
Blood Loss ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Tumor Resection ◽  
Preoperative Embolization ◽  
Digital Subtraction ◽  
Feeding Artery ◽  
Pial Artery

This study evaluated the clinical usefulness of preoperative embolization of the pial artery or dural branch of the internal carotid artery (ICA) for brain tumor. Subjects comprised 17 patients with large hypervascular brain tumors who underwent preoperative selective embolization. Micro-catheters (2- or 1.7-F) and shapeable hydrophilic micro-guide wires were used for pial artery (branching from the posterior or anterior cerebral artery) or ICA dural branch embolization. Embolization was performed under digital subtraction fluoroscopy with Polyvinyl alcohol (PVA) particles (150–250 mm) and/or liquid coil. Tumor resection was performed immediately or the day after embolization. Digital subtraction angiography (DSA) before and after endovascular devascularization, blood loss during tumor resection, and clinical outcome were evaluated. All endovascular procedures were technically successful. Post-embolization DSA revealed either a disappearance or a marked decrease of the tumor stain in all cases. Control of intraoperative bleeding was easily accomplished, and intraoperative blood loss was low. Preoperative particle embolization of the feeding artery from the cortical artery or ICA dural branch is safe and effective as adjuvant therapy before tumor resection.

scholarly journals RADT-19. EFFECTS OF RADIATION DOSE-RATE AND TUMOR CHARACTERISTICS ON LOCAL CONTROL AND TOXICITY AFTER RADIOSURGERY FOR ACOUSTIC NEUROMAS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii185-ii185
Author(s):  
Conrad Josef Villafuerte ◽  
Fred Gentili ◽  
David Shultz ◽  
Alejandro Berlin ◽  
Robert Heaton ◽  
...  
Keyword(s):  
Dose Rate ◽  
Proportional Hazards Model ◽  
Multivariable Analysis ◽  
Tumor Resection ◽  
Local Failure ◽  
Tumor Control ◽  
Tumor Diameter ◽  
Radiation Dose Rate ◽  
Acoustic Neuromas

Abstract INTRODUCTION The effect of stereotactic radiosurgery (SRS) dose-rate on tumor control for acoustic neuroma (AN, or vestibular schwannoma) is unclear. METHODS This was a retrospective study of all patients treated for AN with frame-based cobalt-60 SRS at the Toronto Western Hospital between 2005-2019. Dose rates on the day of SRS were calculated from the calibration dose-rate while accounting for the cobalt-60 half-life of 5.2713 years. Local failure was defined as continued tumor growth >36 months post-SRS, tumor resection for LF, or use of any repeat SRS for LF. Cumulative incidence of LF was reported after accounting for competing risks of death, on a per-lesion basis. Comparisons of actuarial LF were made using Gray’s test. Multivariable analysis of LF was performed using a proportional hazards model. RESULTS A total of 607 patients were treated for 617 acoustic neuromas. Median follow-up was 5.0 years. 158 tumors (26%) were cystic. 71 tumors (12%) had previous resection. Nine patients received 10-11 Gy due to large tumor size; all remaining patients received 12 Gy to approximately the 50% isodose line. Median dose rate was 2.4 Gy/min (range, 1.3-3.7). There was no association between dose rate and LF (≥ 2.4 Gy/min vs. < 2.4 Gy/min, 6.07% vs. 6.12% at 5-year follow-up, p = 0.75). The adjusted local failure-specific hazard ratio (HR) for dose rate (per Gy/min) was 1.2 (95% CI 0.69-2.1, p = 0.52). Patients with previous surgery had higher LF, with a HR of 3.6 (95% CI 1.7-7.8, p = 0.0012), after adjusting for presence of cysts (HR 0.27, p = 0.034) and maximum tumor diameter (HR 1.055 per cm, p = 0.071). CONCLUSIONS In a large cohort of patients with acoustic neuromas, radiosurgery dose-rate was not associated with tumor control. Previous resection was a strong risk factor for local failure after SRS.

scholarly journals Preservation of nasal turbinates in endoscopic, anterior skull base surgery—yes, we can!

2021 ◽  
Author(s):  
Axel Wolf ◽  
Alexandros Andrianakis ◽  
Peter Valentin Tomazic ◽  
Michael Mokry ◽  
Georg Clarici ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Tumor Resection ◽  
Tumor Location ◽  
Anterior Skull Base ◽  
Tumor Diameter ◽  
Tumor Type ◽  
Preoperative Information ◽  
Medical University ◽  
Significant Factors

Abstract Objective To evaluate the frequency, type and indications of nasal turbinate (NT) resection during endoscopic, anterior skull base surgery and to analyze factors that may have an impact on the need of NT removal. Methods In this retrospective cohort study, 306 subjects (150 males and 156 females, mean age 55.4 ± 15.3 years) who underwent multidisciplinary, transnasal, endoscopic tumor surgery of the anterior skull base using 4-handed techniques between 2011 and 2019 at the Department of Otorhinolaryngology, Medical University of Graz, were included. Results In the majority of interventions (n = 281/306; 91.8%), all NT were preserved. Significant factors influencing the need of NT resections turned out to be type of endoscopic approach (p < 0.001; V = 0.304), sagittal (p = 0.003; d = 0.481) and transversal (p = 0.017; d = 0.533) tumor diameter, tumor type (p < 0.001; V = 0.355) and tumor location (p < 0.001; V = 0.324). Conclusions NT can be preserved in the majority of patients undergoing tumor resection in anterior, transnasal, skullbase surgery and routine resection of NT should be avoided. Variables that have an impact on the need of NT resections are types of endoscopic approaches, sagittal and transversal tumor extension and tumor type. These factors should be considered in planning of surgery and preoperative information of patients.

Preoperative identification of the facial nerve in patients with large cerebellopontine angle tumors using high-density diffusion tensor imaging

2012 ◽  
Vol 116 (4) ◽  
pp. 697-702 ◽  
Author(s):  
Neil Roundy ◽  
Johnny B. Delashaw ◽  
Justin S. Cetas
Keyword(s):  
Diffusion Tensor Imaging ◽  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Diffusion Tensor ◽  
Tumor Resection ◽  
High Density ◽  
Imaging Method ◽  
Study Objective ◽  
Nerve Preservation ◽  
Imaging Results

Object Facial nerve paresis can be a devastating complication following resection of large (> 2.5 cm) cerebellopontine angle (CPA) tumors. The authors have developed and used a new high-density diffusion tensor imaging (HD-DT imaging) method, aimed at preoperatively identifying the location and course of the facial nerve in relation to large CPA tumors. Their study objective was to preoperatively identify the facial nerve in patients with large CPA tumors and compare their HD-DT imaging method with a traditional standard DT imaging method and correlate with intraoperative findings. Methods The authors prospectively studied 5 patients with large (> 2.5 cm) CPA tumors. All patients underwent preoperative traditional standard- and HD-DT imaging. Imaging results were correlated with intraoperative findings. Results Utilizing their HD-DT imaging method, the authors positively identified the location and course of the facial nerve in all patients. In contrast, using a standard DT imaging method, the authors were unable to identify the facial nerve in 4 of the 5 patients. Conclusions The HD-DT imaging method that the authors describe and use has proven to be a powerful, accurate, and rapid method for preoperatively identifying the facial nerve in relation to large CPA tumors. Routine integration of HD-DT imaging in preoperative planning for CPA tumor resection could lead to improved facial nerve preservation.

scholarly journals Bilateral angiomyolipoma of the kidney in patient with tuberous sclerosis

2005 ◽  
Vol 133 (9-10) ◽  
pp. 433-437
Author(s):  
Radoje Colovic ◽  
Natasa Colovic ◽  
Nikica Grubor ◽  
Vladimir Radak ◽  
Marijan Micev ◽  
...  
Keyword(s):  
Tuberous Sclerosis ◽  
Complete Loss ◽  
Hla Typing ◽  
Uneventful Recovery ◽  
Loss Of Function ◽  
Kidney Tumors ◽  
Benign Nature ◽  
The Right ◽  
Slow Growing

Angiomyolipomas are relatively frequent tumors of the kidney. It is believed that about 10 million people worldwide have such a tumor. About 1/10 of these 10 million are patients who suffer from tuberous sclerosis. The tumors are frequently bilateral, slow growing, and usually a symptomatic, as well as being rare in children. Due to the benign nature of angiomyolipomas, surgical treatment and embolisation of the tumors are generally not recommended, unless renal function is endangered, the symptoms are severe, or the kidney in question becomes completely dysfunctional. This is particularly the case in patients with tuberous sclerosis in whom these tumors are either already bilateral or may become so. We present a 24-year-old woman with tuberous sclerosis in whom bilateral kidney tumors were diagnosed 7 years earlier and in whom we carried out a left nephrectomy of a 5300 gram angiomyolipoma, which caused pain and complete loss of function. Although timorous, the right kidney was functional, so it was left untouched. After an uneventful recovery, a close follow-up was recommended, as well as HLA typing, as it is highly probable that the right kidney will gradually become inadequate or completely dysfunctional, so that haemodialysis and/or kidney transplantation along with nephrectomy will become necessary.

scholarly journals Postoperative Adjuvant Radiotherapy Can Delay the Recurrence of Desmoid Tumors After R0 Resection in Certain Subgroups

2021 ◽  
Vol 8 ◽  
Author(s):  
Tielong Yang ◽  
Haotian Liu ◽  
Zhichao Liao ◽  
Chao Zhang ◽  
Lijie Xiang ◽  
...  
Keyword(s):  
Adjuvant Radiotherapy ◽  
Clinical Symptoms ◽  
Tumor Resection ◽  
Final Analysis ◽  
Postoperative Recurrence ◽  
R0 Resection ◽  
Tumor Diameter ◽  
Desmoid Tumors ◽  
Entire Cohort ◽  
Single Tumor

Background: When patients with desmoid tumors (DTs) present uncontrolled clinical symptoms, surgery is an effective treatment, but the high postoperative recurrence rate is a major problem. The significance of adjuvant radiotherapy has been debated for many years, and the significance of aggressive surgery has not been reported.Methods: Medical records for DT patients were collected. KM analysis and the Mann–Whitney U-test were performed to evaluate the role of radiotherapy and aggressive surgery in the entire cohort and different subgroups.Results: Of 385 DT patients, 267 patients with R0 resection were included in the final analysis. A total of 53 patients (19.85%) experienced recurrence. Although radiotherapy showed no significant effect on recurrence-free survival (RFS) or time to recurrence (TTR) in the entire cohort, radiotherapy delayed recurrence in the age ≤ 30 years old subgroup (TTR = 35 months with surgery plus radiotherapy, TTR = 11 months with surgery alone; p = 0.014) and the tumor diameter &gt;5 cm subgroup (TTR = 26 months with surgery plus radiotherapy, TTR = 11 months with surgery alone; p = 0.02) among patients with a single tumor. Aggressive surgery improved RFS in the tumor diameter &gt;5 cm subgroup (p = 0.049) but not the entire cohort.Conclusions: Although radiotherapy cannot improve RFS, it can delay recurrence in the age ≤ 30 years old subgroup and the tumor diameter &gt;5 cm subgroup among patients with a single tumor. For patients with large invasive tumors and multiple involved sites, aggressive surgery could be selected to achieve complete tumor resection to improve RFS.

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