OJU  Vol.3 No.2 , May 2013
CT Appearance Following Partial Nephrectomy for Renal Cell Carcinoma Using Tissue Adhesive Bioglue
Abstract: Background: The use of biological sealants has greatly increased during nephron sparing surgery. In many cases the bulk of the material was erroneously mistaken for tumor recurrence. Objective: To describe the characteristic appearance of biological adhesive material used for tumor bed closure on computerized tomography (CT) following nephrone sparing surgery (NSS) for renal cell carcinoma, in order to differentiate between typical features of the adhesive material and local tumor recurrence. Design, Setting and Participants: We retrospectively reviewed follow-up CT scans of 120 patients who underwent NSS for T1N0M0 RCC. In all cases tumor bed was closed during surgery with biological tissue adhesive (BioGlue). Results and Limitations: During 1994-2009, 120 patients with a single T1 renal cell carcinoma lesion, underwent NSS with closure of tumor bed with bio adhesive material. There were 66 males and 47 females with mean age of 58.7 years (median: 58 years, range: 28 - 85 years). Mean follow-up time was 45 ± 34 months (median 42, range 12 - 168). During follow-up, 3 patients had local recurrence at the site of previous enucleated lesion. In the first post-operative CT scan the BG appeared as a heterogeneous mass with sharp edges measuring 20 - 70 HU with no attenuation following the injection of contrast material. In subsequent follow-up scans the BG in most patients remained stable in size; in few patients slight reduction in size was observed probably due to the resolution of post-operative hematoma. Tumor recurrence that was documented in 3 patients was seen as a heterogeneous mass with attenuation of more than 20 HU following the injection of contrast material. In sequential CT’s the mass was increasing in size. Conclusions: BG appears as a non-enhancing stable mass in sequential CT’s following NSS, hence could be differentiated from local tumor recurrence. The ability to differentiate between normal post-operative status and recurrence could be compromised in patients with decreased renal function in whom contrast material could not be used.
Cite this paper: S. Croituro, Y. Braz, B. Moskovitz, O. Nativ and S. Halachmi, "CT Appearance Following Partial Nephrectomy for Renal Cell Carcinoma Using Tissue Adhesive Bioglue," Open Journal of Urology, Vol. 3 No. 2, 2013, pp. 75-79. doi: 10.4236/oju.2013.32015.

[1]   F. Becker, S. Siemer, U. Humke, M. Hack, M. Ziegler and M. Stockle, “Elective Nephron Sparing Surgery Should Become Standard Treatment for Small Unilateral Renal Cell Carcinoma: Long-Term Survival Data of 216 Patients,” European Urology, Vol. 49, No. 2, 2006, pp. 308-313. doi:10.1016/ ruro.2005.10.020

[2]   W. K. Lau, M. L. Blute, A. L. Weaver, V. E. Torres and H. Zincke, “Matched Comparison of Radical Nephrectomy vs Nephron-Sparing Surgery in Patients with Unilateral Renal Cell Carcinoma and a Normal Contralateral Kidney,” Mayo Clinic Proceeding, Vol. 75, No. 12, 2000, pp. 1236-1242. doi:10.4065/75.12.1236

[3]   F. Porpiglia, J. Renard, M. Billia, I. Morra, C. Terrone and R. M. Scarpa, “Biological Glues and Collagen Fleece for Hemostasis during Laparoscopic Partial Nephrectomy: Technique and Results of Prospective Study,” Journal of Endourology, Vol. 21, No. 4, 2007, pp. 423-428. doi:10.1089/end. 2006.0265

[4]   G. Hidas, L. Lupinsky, A. Kastin, B. Moskovitz, D. Groshar and O. Nativ, “Functional Significance of Using Tissue Adhesive Substance in Nephron-Sparing Surgery: Assessment by Quantitative SPECT of 99 m Tc-Dimercaptosuccinic Acid Scintigraphy,” European Urology, Vol. 52, No. 3, 2007, pp. 785-789. doi:10.1016/j.eururo.2006.12.001

[5]   O. Nativ, A. Levi, R. Farfara, S. Halachmi and B. Moskovitz, “Degree and Predictors of Functional Loss of the Operated Kidney following Nephron-Sparing Surgery: Assessment by Quantitative SPECT of 99 m Tc-Dimercaptosuccinic Acid Scintigraphy,” Advances in Urology, Vol. 2011, 2011, Article ID: 961525.

[6]   C. J. Kane, K. Mallin, J. Ritchey, M. R. Cooperberg and P. R. Carroll, “Renal Cell Cancer Stage Migration: Analysis of the National Cancer Data Base,” Cancer, Vol. 113, No. 1, 2008, pp. 78-83. doi:10.1002/cncr.23518

[7]   A. Antonelli, A. Cozzoli, M. Nicolai, D. Zani, T. Zanotelli, L. Perucchini, S. C. Cunico and C. Simeone, “Nephron-Sparing Surgery Versus Radical Nephrectomy in the Treatment of Intracapsular Renal Cell Carcinoma up to 7 cm,” European Urology, Vol. 53, No. 4, 2008, pp. 803-809. doi:10.1016/j.eur uro.2007.11.007

[8]   J. J. Patard, O. Shvarts, J. S. Lam, A. J. Pantuck, H. L. Kim, V. Ficarra, L. Cindolo, K. R. Han, T. A. De La, J. Tostain, W. Artibani, C. C. Abbou, B. Lobel, D. K. Chopin, R. A. Figlin, P. F. Mulders and A. S. Belldegrun, “Safety and Efficacy of Partial Nephrectomy for All T1 Tumors Based on an International Multicenter Experience,” The Journal of Urology, Vol. 171, No. 6, 2004, pp. 2181-2185. doi:10.1097/01.ju.0000124846.37299.5e

[9]   J. H. Kaouk, S. P. Hillyer, R. Autorino, G. P. Haber, T. Gao, F. Altunrende, R. Khanna, G. Spana, M. A. White, H. Laydner, W. Isac and R. J. Stein, “252 Robotic Partial Nephrectomies: Evolving Renorrhaphy Technique and Surgical Outcomes at a Single Institution,” Urology, Vol. 78, No. 6, 2011, pp. 1338-1344.

[10]   D. S. Park and W. K. Jang, “Secure Reconstruction Technique after Partial Nephrectomy Irrespective of Tumor Size and Location,” International Brazilian Journal of Urology, Vol. 35, No. 4, 2009, pp. 416-426. doi:10.1590/S1677-55382009000400004

[11]   J. Sammon, F. Petros, S. Sukumar, A. Bhandari, S. Kaul, M. Menon and C. Rogers, “Barbed Suture for Renorrhaphy during Robot-Assisted Partial Nephrectomy,” Journal of Endourology, Vol. 25, No. 3, 2011, pp. 529-533. doi:10.1089/end.2010.0455

[12]   J. Simon, F. Finter, A. Ignatius, M. Meilinger and L. Durselen, “Maximum Tensile Force of Different Suture Techniques in Reconstruction of the Renal Remnant after Nephron-Sparing Surgery,” Surgical Endoscopy, Vol. 25, No. 2, 2011, pp. 503-507. doi:10.1007/s00464-010-1201-0

[13]   A. Celia, G. Zeccolini, G. Guazzoni, V. Pansadoro, V. Disanto, F. Porpiglia, C. Milani, C. Abbou, R. Gaston, G. Janetschek, N. A. Soomroo, P. Fornara, A. Breda, P. G. Schulam, R. J. De la, M. P. Laguna, J. Palou and G. Breda, “Laparoscopic Nephron Sparing Surgery: A MultiInstitutional European Survey of 592 Cases,” Archives of Italian Urology and Andrology, Vol. 80, No. 3, 2008, pp. 85-91.

[14]   H. Jung, J. P. Brusky and G. W. Chien, “BioGlue Presenting as Radiographic Emphysematous Pyelonephritis after Laparoscopic Partial Nephrectomy,” Journal of Endourology, Vol. 24, No. 6, 2010, pp. 945-946. doi:10.1089/end.2009.0505

[15]   A. C. Mues, J. A. Graversen, M. D. Truesdale, C. Casazza and J. Landman, “BioGlue Iceball Stabilization to Minimize the Risk of Hemorrhage during Laparoscopic Renal Cryoablation,” Urology, Vol. 78, No. 2, 2011, pp. 353-356. doi:10.1016/j.urology.2011.01.072

[16]   K. S. Hafez, A. C. Novick and S. C. Campbell, “Patterns of Tumor Recurrence and Guidelines for Followup after Nephron Sparing Surgery for Sporadic Renal Cell Carcinoma,” The Journal of Urology, Vol. 157, No. 6, 1997, pp. 2067-2070. doi:10.1016/S0022-5347(01)64675-5

[17]   P. H. Van, B. Bamelis, R. Oyen and L. Baert, “Partial Nephrectomy for Renal Cell Carcinoma Can Achieve Long-Term Tumor Control,” The Journal of Urology, Vol. 160, No. 3, 1998, pp. 674-678.

[18]   R. Zigeuner, F. Quehenberger, K. Pummer, P. Petritsch and G. Hubmer, “Long-Term Results of Nephron-Sparing Surgery for Renal Cell Carcinoma in 114 Patients: Risk Factors for Progressive Disease,” BJU International, Vol. 92, No. 6, 2003, pp. 567-571. doi:10.1046/j.1464-410X.2003.04414.x

[19]   K. S. Hafez, A. C. Novick and S. C. Campbell, “Patterns of Tumor Recurrence and Guidelines for Followup after Nephron Sparing Surgery for Sporadic Renal Cell Carcinoma,” The Journal of Urology, Vol. 157, No. 6, 1997, pp. 2067-70. doi:10.1016/S0022-5347(01)64675-5

[20]   M. S. Lee, T. O. Young, K. H. Woong, H. R. Koon, D. C. Young, J. H. Sung, C. Y. Seung and W. K. Ki, “CT Findings after Nephron-Sparing Surgery of Renal Tumors,” American Journal of Roentgenology, Vol. 189, No. 5, 2007, pp. 264-271. doi:10.2214/AJR.07.2542

[21]   D. Pai, J. M. Willatt, M. Korobkin, R. H. Cohan, J. H. Ellis, I. R. Francis, J. S. Wolf and M. Schipper, “CT Appearances Following Laparoscopic Partial Nephrectomy for Renal Cell Carcinoma Using a Rolled Cellulose Bolster,” Cancer, Vol. 10, No. 1, 2010, pp. 161-168. doi:10.1102/1470-7330.2010.0023