Approaches to kidney anti-ischemic protection in organ-preserving surgical treatment of patients with renal cell cancer

Abstract

The advantages of organ-preserving kidney operations are the improvement of functional results, the reduction in the number of patients with end-stage chronic renal failure in long-term follow up and related cardiovascular complications along with overall patients quality of life improvement. On the one hand, a dry surgical field is necessary for visualizing the resection margin and on the other hand, its creation starts the process of acute ischemic damage to the tissue of the operated kidney. Each minute of kidney ischemia proportionally increases the risk of developing renal failure in the long-term postoperative period. It is especially important to consider the duration of ischemia during operations on a single kidney, with bilateral tumor lesions of the kidneys, as well as in the presence of chronic renal failure. After resection of the kidney, its residual function depends on the preoperative level of glomerular filtration, the amount of parenchyma retained during surgery, and the duration of renal ischemia. The predicted functional insufficiency of the healthy contralateral kidney in the postoperative period is 18%. The possibility of the chronic renal failure onset or worsening of the existing one due to the progression of nephrosclerosis reaches almost 80%. The development of chronic renal failure stage III and above in the long term after renal resection is more than 30%. Thus, there is a need for the development of precision surgery, as well as the search for anti-ischemic kidney protection, aimed at maintaining the maximum volume of functioning renal parenchyma.