Lublin: Doctors helped two patients with kidney cancer. Instead of surgery, there were minimally invasive procedures

IN Independent Public Hospital Kliniczne No. 4 at ul. Jaczewski in Lublin the first cryoablation procedures for kidney cancer took place. This is a new, minimally invasive direction of treatment.

– Until recently, there was no alternative for patients with a small kidney tumor (less than 4 cm) who did not qualify for sparing surgery, i.e. removal of the tumor with a margin of healthy tissue. We are talking mainly about patients with significant co-morbidities or other contraindications to classic surgical methods – informs the hospital. – Interventional radiology, and in particular its branch of surgical oncology, is a dynamically developing field of medicine. Hand in hand with urology, they faced the challenge of the 21st century, which is to minimize the invasiveness of procedures, and thus reduce the number of complications, shorter hospital stays and faster patient recovery.

The hospital explains that cryoablation is the least invasive method of removing small kidney tumors. The method does not involve cutting out the tumor, but destroying it. This procedure is performed without opening the abdominal cavity. Doctors puncture the tumor through the skin using a special needle, at the end of which a temperature of minus 190 degrees Celsius is generated. Complications after cryoablation occur much less frequently than in the case of classic operations. Cryoablation may be the preferred method of treatment in older patients, those with high burdens and those who are at high risk of clinically significant progression of chronic kidney disease due to classic surgery. The next group are patients in whom there are indications that a classic surgical procedure could be technically difficult, e.g. due to previous surgeries.

In Poland, few centers perform the cryoablation procedure for kidney cancer. On Saturday (November 18), the procedure was performed on two patients of SPSK No. 4 in Lublin. 52-year-old Artur Chudziak was born without one kidney. The lack of development of this organ is called agenesis. Whereas a tumor was detected in the only functioning kidney.

– Standard surgery could involve removing the only functioning kidney, and I didn’t want to take that risk. To the hospital at ul. Jaczewski, I came from Stalowa Wola. Lublin was the closest city where I could have the cryoablation procedure performed. It was performed under local anesthesia, with me fully conscious. An anesthesiologist supervised my comfort. The whole thing lasted about an hour. Now I feel great. Just four hours after the procedure, I got up and went to the bathroom. The next day I was walking and eating normally, says the patient.

The tumor was located deep in the kidney parenchyma. Standard surgery would involve the risk of losing the entire organ.

The next patient who underwent the procedure was a 56-year-old man who had two right kidney tumors located in the upper and lower poles, and additionally had a left kidney tumor surgically removed in another center. Due to his experience, he preferred minimally invasive treatment.

Cryoablation can be performed using intraoperative cryoprobes under laparoscopic or thoracoscopic image control, as well as percutaneously under ultrasound or computed tomography control, which guarantees high precision of needle placement. Tomography allows the procedure to be performed safely, and in the event of bleeding, interventional radiologists can immediately embolize the damaged vessels. For this reason good cooperation between urologists, radiologists and anesthesiologists in performing the procedure is necessary.

Both procedures were performed by a team consisting of: dr hab. Krzysztof Pyra, prof. Medical University, Maciej Szmygin, M.D., Ph.D. med. Łukasz Światłowski, instrumentalists Izabela Staszek, M.A., Katarzyna Hać, M.A. from the Department of Interventional Radiology and Neuroradiology, SPSK No. 4 in Lublin, med. Paweł Buraczyński and M.D. Michał Godzisz from the Clinical Department of Urology and Urological Oncology SPSK No. 4, MD. Wiesław Sochocki and nurse Leszek Chomicki from the Clinical Department of Anesthesiology and Intensive Care of SPSK No. 4 in Lublin, x-ray technicians Marcelina Wilk and Andrzej Janczyk from the Department of Radiology and Nuclear Medicine, proctor from the Medical University of Wrocław, interventional radiologist dr hab. Maciej Guziński, who supervised the whole thing. Dr. Guziński was previously associated with the Lublin center. He began his adventure with interventional radiology under the supervision of the former head of the Department of Interventional Radiology and Neuroradiology of SPSK No. 4 in Lublin, prof. Ph.D. Małgorzata Szczerbo-Trojanowska.

– A new direction in the treatment of kidney cancer exists thanks to the possibilities offered by interventional radiology. This is an extremely dynamically developing field of medicine. In Poland, particular emphasis is placed on the development of surgical oncology. We want this development to also include our hospital, hence, among others: cryoablation, which was reimbursed by the National Health Fund this year. We want to introduce this type of modern, minimally invasive methods with our patients in mind. They guarantee greater safety, lower risk of complications, and a faster return to normal functioning after the procedure – explains Dr. Hab. Krzysztof Pyraa radiologist who initiated the project together with Dr. Buraczyński.

– First, we find the lesion in the kidney under ultrasound guidance, and then we puncture it with cryoablation needles. A non-contrast computed tomography scan is performed to check the precision of the needle position. When we determine that it is correct, we start cryoablation. The temperature in the cryoablation zone reaches minus 40 degrees thanks to the use of a frozen noble gas – argon. The so-called “ice ball”, the formation of which we can constantly monitor thanks to tomography. The actual freezing of the tumor takes about half an hour. After the procedure is completed, a follow-up tomography is performed. It allows you to determine whether there has been any bleeding. After a day of observation in the hospital, the patient can be discharged home – says the urologist. Paweł Buraczyński from the Clinical Department of Urology and Urological Oncology, SPSK No. 4 in Lublin.

In Poland, there are approximately 5 thousand cases. cases of renal cell carcinoma per year. In recent years, a significant increase in the number of patients has been observed, which is related to the greater number of imaging tests performed than before and the extension of society’s lifespan.