Photodynamic diagnostics of surgical margins during partial nephroectomy for kidney cancer

The main criteria for the efficacy estimation of the organ-preservation surgery in patients with kidney cancer (KC) is the incidence of local recurrences and survival outcomes. The main cause of the local recurrence is non-radical manner of excision and multifocal tumor growth. Our study included 56 patients with KC which were treated operatively: 20 (35.7%) patients with open partial nephrectomy, 36 (64.2%) patients with laparoscopic partial nephrectomy. As photosensibilizer ‘Alasens’ (Russia) was used (5-aminolevulenic acid). Spectroscopic assessment of fluorescence was performed with the use of laser spectral apparatus LESA-01-BIOSPEK. In forty seven patients (84%) a positive fluorescence was not evident in the area of the surgical margin, which was confirmed also as the histologically apparent absence of tumor tissue in the margin. In 9 patients (16%, 4 patients with open, 5 with laparoscopic operation) positive fluorescence of the surgical margin was detected. In 7 patients (12%) of this group positive surgical margin was found as the result of pathomorphological investigation, in 2 patients (3%) a conclusion of false luminescence was made with angiomyolipoma as a finding at pathomorphology. The sensitivity of the method was found to be 78%, specificity - 84%. Drawing a conclusion, a high efficacy was shown for fluorescence as a method of the radicalism control during the organ-preserving operations on kidney. This accounts for a decrease in the risk of local recurrence and, consequently, for a better survival.