Tumor 4–7 cm: is resection possible?
The decision is made using MSCT with assessment of nephrometric parameters (depth, proximity to the sinus and vessels, polarity): exophytic peripheral tumors are resected laparoscopically, central tumors are resected openly or the kidney is removed. Clamping of the artery for up to 25 minutes, if necessary, selective clamping of a segmental branch or cooling. The opened calyces are sutured separately, the parenchyma is sutured with a double-row suture. Due to the volume of reconstruction, the risk of bleeding and urinary leakage is higher (5–8%), so drainage costs longer. Histology with assessment of resection margins determines observation.
Why save a kidney?
For tumors up to 4 cm (T1a) and in many cases up to 7 cm, partial nephrectomy gives the same oncological result as removing the entire kidney, but preserves function - this reduces the risk of chronic kidney disease, cardiovascular complications and is important for a solitary kidney, bilateral tumors, diabetes and hypertension. Current standards recommend resection for all tumors where it is technically feasible.
Difficulty categories and access
In the price list, resection is divided by tumor size: up to 4 cm, 4–7 cm, more than 7 cm - the larger and deeper the tumor, the more difficult the kidney reconstruction and the longer the ischemia. Laparoscopic resection is the standard for peripheral and exophytic tumors; open is performed for central, multiple tumors, a single kidney and complex anatomy, when tactile control and minimal ischemia time are needed.
Results
Local recurrence after resection is 2–5%, 5-year survival rate for T1 is 90–95%. The function of the operated kidney decreases slightly if ischemia does not exceed 20–25 minutes. The main complications are bleeding and urinary drip (3–5%), which are controlled by drainage and, if necessary, embolization or a stent.
