Multidetector CT imaging of complications after laparoscopic nephron-sparing surgery

Insights into Imaging - Tập 6 - Trang 465-478 - 2015
Massimo Tonolini1, Anna Maria Ierardi2, Virginia Varca3, Giacomo Piero Incarbone3, Marina Petullà1, Roberto Bianco1
1Department of Radiology, “Luigi Sacco” University Hospital, Milan, Italy
2Interventional Radiology, Department of Radiology, University of Insubria, Varese, Italy
3Department of Urology, “Luigi Sacco” University Hospital, Milan, Italy

Tóm tắt

Laparoscopic nephron-sparing surgery (L-NSS) is increasingly performed to treat localised renal lesions. However, the associated morbidity is non-negligible, with a rate of major complications approaching 10 %. This paper provides an overview of indications, surgical techniques and results of L-NSS; explains the incidence, risk factors and manifestations of postoperative complications; discusses the preferred multidetector computed tomography (CT) acquisition techniques; illustrates the appearance of normal postoperative images following L-NSS; and reviews, with example images, the most common and unusual iatrogenic complications. These include haematuria, haemorrhage, vascular injuries, infections and urinary leaks. Most emphasis is placed on CT, which provides rapid, reliable triage and follow-up of iatrogenic complications after L-NSS, identifying occurrences that require transarterial embolisation or repeated surgery. Multidetector CT allows precise assessment of the surgical resection site; detection of pneumoperitoneum and subcutaneous emphysema; quantification of retroperitoneal blood; and identification of active bleeding, pseudoaneurysms, arterio-venous fistulas, abscess collections and extravasated urine. • Laparoscopic nephron-sparing surgery (NSS) is increasingly performed to treat renal lesions. • Radiologists are increasingly requested to investigate suspected post-surgical NSS complications. • Post-NSS complications include haemorrhage, haematuria, vascular injuries, infections and urinary leaks. • Multidetector CT allows choice between conservative treatment, transarterial embolisation or surgery.

Tài liệu tham khảo

Ljungberg B, Bensalah K, Bex A et al (2014) Guidelines on Renal Cell Carcinoma. European Association of Urology (EAU). Available at: http://www.uroweb.org/gls/pdf/10%20Renal%20Cell%20Carcinoma_LR.pdf. Accessed 2015/02/10

Ljungberg B, Cowan NC, Hanbury DC et al (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58:398–406

Hindman NM, Kang S, Parikh MS (2014) Common postoperative findings unique to laparoscopic surgery. Radiographics 34:119–138

Huang WC, Levey AS, Serio AM et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7:735–740

Lau WK, Blute ML, Weaver AL et al (2000) Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 75:1236–1242

Campero JM, Ramos CG, Valdevenito R et al (2012) Laparoscopic partial nephrectomy: a series of one hundred cases performed by the same surgeon. Urol Ann 4:162–165

Dominguez-Escrig JL, Vasdev N, O’Riordon A et al (2011) Laparoscopic partial nephrectomy: technical considerations and an update. J Minim Access Surg 7:205–221

Gill IS, Kavoussi LR, Lane BR et al (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178:41–46

Reifsnyder JE, Ramasamy R, Ng CK et al (2012) Laparoscopic and open partial nephrectomy: complication comparison using the Clavien system. JSLS 16:38–44

Springer C, Hoda MR, Fajkovic H et al (2013) Laparoscopic vs open partial nephrectomy for T1 renal tumours: evaluation of long-term oncological and functional outcomes in 340 patients. BJU Int 111:281–288

Touma NJ, Matsumoto ED, Kapoor A (2012) Laparoscopic partial nephrectomy: the McMaster University experience. Can Urol Assoc J 6:233–236

Wheat JC, Roberts WW, Hollenbeck BK et al (2013) Complications of laparoscopic partial nephrectomy. Urol Oncol 31:57–62

Liu Z, Wang P, Xia D et al (2013) Comparison between laparoscopic and open partial nephrectomy: surgical, oncologic, and functional outcomes. Kaohsiung J Med Sci 29:624–628

Minervini A, Siena G, Antonelli A et al (2014) Open versus laparoscopic partial nephrectomy for clinical T1a renal masses: a matched-pair comparison of 280 patients with TRIFECTA outcomes (RECORd Project). World J Urol 32:257–263

Xu H, Ding Q, Jiang HW (2014) Fewer complications after laparoscopic nephrectomy as compared to the open procedure with the modified Clavien classification system—a retrospective analysis from southern China. World J Surg Oncol 12:242

Becker A, Pradel L, Kluth L et al (2014) Laparoscopic versus open partial nephrectomy for clinical T1 renal masses: no impact of surgical approach on perioperative complications and long-term postoperative quality of life. World J Urol 33:421–426

Klatte T, Shariat SF, Remzi M (2014) Systematic review and meta-analysis of perioperative and oncologic outcomes of laparoscopic cryoablation versus laparoscopic partial nephrectomy for the treatment of small renal tumors. J Urol 191:1209–1217

Kapoor A, Wang Y, Dishan B et al (2014) Update on cryoablation for treatment of small renal mass: oncologic control, renal function preservation, and rate of complications. Curr Urol Rep 15:396

Atwell TD, Schmit GD, Boorjian SA et al (2013) Percutaneous ablation of renal masses measuring 3.0 cm and smaller: comparative local control and complications after radiofrequency ablation and cryoablation. AJR Am J Roentgenol 200:461–466

Schmit GD, Thompson RH, Kurup AN et al (2013) Usefulness of R.E.N.A.L. nephrometry scoring system for predicting outcomes and complications of percutaneous ablation of 751 renal tumors. J Urol 189:30–35

El Dib R, Touma NJ, Kapoor A (2012) Cryoablation vs radiofrequency ablation for the treatment of renal cell carcinoma: a meta-analysis of case series studies. BJU Int 110:510–516

Israel GM, Hecht E, Bosniak MA (2006) CT and MR imaging of complications of partial nephrectomy. Radiographics 26:1419–1429

Lee MS, Oh YT, Han WK et al (2007) CT findings after nephron-sparing surgery of renal tumors. AJR Am J Roentgenol 189:W264–W271

Saddala P, Ramanathan S, Tirumani SH et al (2015) Complications of minimally invasive procedures of the abdomen and pelvis: a comprehensive update on the clinical and imaging features. Emerg Radiol 22:283-294

Sarwani NI, Motta Ramirez GA, Remer EM et al (2007) Imaging findings after minimally invasive nephron-sparing renal therapies. Clin Radiol 62:333–339

Parsons RB, Canter D, Kutikov A et al (2012) RENAL nephrometry scoring system: the radiologist’s perspective. AJR Am J Roentgenol 199:W355–W359

Chapin BF, Delacroix SE Jr, Wood CG (2011) Renal cell carcinoma: what the surgeon and treating physician need to know. AJR Am J Roentgenol 196:1255–1262

Canter D, Kutikov A, Manley B et al (2011) Utility of the R.E.N.A.L. nephrometry scoring system in objectifying treatment decision-making of the enhancing renal mass. Urology 78:1089–1094

Mucksavage P, McDougall EM, Clayman RV (2011) Laparoscopic transperitoneal nephrectomy for renal cancer: the University of California, Irvine, technique. J Endourol 25:195–200

Haber GP, Gill IS (2006) Laparoscopic partial nephrectomy: contemporary technique and outcomes. Eur Urol 49:660–665

Kang N, Niu Y, Zhang J et al (2012) Intraoperative ultrasonography: a useful tool in retrolaparoscopic nephron-sparing surgery. Urol Int 88:338–342

Summerton DJ, Kitrey ND, Lumen N et al (2012) EAU guidelines on iatrogenic trauma. Eur Urol 62:628–639

Mitropoulos D, Artibani W, Biyani CS et al (2014) Quality assessment of partial nephrectomy complications reporting using EAU standardised quality criteria. Eur Urol 66:522–526

Simhan J, Smaldone MC, Tsai KJ et al (2011) Objective measures of renal mass anatomic complexity predict rates of major complications following partial nephrectomy. Eur Urol 60:724–730

Reddy UD, Pillai R, Parker RA et al (2014) Prediction of complications after partial nephrectomy by RENAL nephrometry score. Ann R Coll Surg Engl 96:475–479

Yang CM, Chung HJ, Huang YH et al (2014) Standardized analysis of laparoscopic and robotic-assisted partial nephrectomy complications with Clavien classification. J Chin Med Assoc 77:637–641

Fardoun T, Chaste D, Oger E et al (2014) Predictive factors of hemorrhagic complications after partial nephrectomy. Eur J Surg Oncol 40:85–89

Ellison JS, Montgomery JS, Hafez KS et al (2013) Association of RENAL nephrometry score with outcomes of minimally invasive partial nephrectomy. Int J Urol 20:564–570

Liu ZW, Olweny EO, Yin G et al (2013) Prediction of perioperative outcomes following minimally invasive partial nephrectomy: role of the R.E.N.A.L nephrometry score. World J Urol 31:1183–1189

Long JA, Arnoux V, Fiard G et al (2013) External validation of the RENAL nephrometry score in renal tumours treated by partial nephrectomy. BJU Int 111:233–239

Hayn MH, Schwaab T, Underwood W et al (2011) RENAL nephrometry score predicts surgical outcomes of laparoscopic partial nephrectomy. BJU Int 108:876–881

Mathieu R, Verhoest G, Droupy S et al (2013) Predictive factors of complications after robot-assisted laparoscopic partial nephrectomy: a retrospective multicentre study. BJU Int 112:E283–E289

Kruck S, Anastasiadis AG, Walcher U et al (2012) Laparoscopic partial nephrectomy: risk stratification according to patient and tumor characteristics. World J Urol 30:639–646

Cano Alonso R, Borruel Nacenta S, Diez Martinez P et al (2009) Kidney in danger: CT findings of blunt and penetrating renal trauma. Radiographics 29:2033–2053

Thomsen HS, Webb JAW (eds) (2009) Contrast media: safety issues and ESUR guidelines. Springer, New York

Stacul F, van der Molen AJ, Reimer P et al (2011) Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 21:2527–2541

Kekelidze M, Dwarkasing RS, Dijkshoorn ML et al (2010) Kidney and urinary tract imaging: triple-bolus multidetector CT urography as a one-stop shop—protocol design, opacification, and image quality analysis. Radiology 255:508–516

Van Der Molen AJ, Cowan NC, Mueller-Lisse UG et al (2008) CT urography: definition, indications and techniques. A guideline for clinical practice. Eur Radiol 18:4–17

Titton RL, Gervais DA, Hahn PF et al (2003) Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics 23:1133–1147

Hope WW, Heniford BT, Norton HJ et al (2009) Duration and clinical significance of radiographically detected “free air” after laparoscopic nephrectomy. Surg Laparosc Endosc Percutan Tech 19:415–418

Borofsky S, Taffel M, Khati N et al (2015) The emergency room diagnosis of gastrointestinal tract perforation: the role of CT. Emerg Radiol 22:315-327

Tonolini M, Campari A, Bianco R (2012) Common and unusual diseases involving the iliopsoas muscle compartment: spectrum of cross-sectional imaging findings. Abdom Imaging 37:118–139

Cohenpour M, Strauss S, Gottlieb P et al (2007) Pseudoaneurysm of the renal artery following partial nephrectomy: imaging findings and coil embolization. Clin Radiol 62:1104–1109

Albani JM, Novick AC (2003) Renal artery pseudoaneurysm after partial nephrectomy: three case reports and a literature review. Urology 62:227–231

Ierardi AM, Floridi C, Fontana F et al (2014) Transcatheter embolisation of iatrogenic renal vascular injuries. Radiol Med 119:261–268

Hatzidakis A, Rossi M, Mamoulakis C et al (2014) Management of renal arteriovenous malformations: a pictorial review. Insights Imaging 5:523–530

Stunell H, Buckley O, Feeney J et al (2007) Imaging of acute pyelonephritis in the adult. Eur Radiol 17:1820–1828

Craig WD, Wagner BJ, Travis MD (2008) Pyelonephritis: radiologic-pathologic review. Radiographics 28:255–277, quiz 327–258

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Insights into Imaging

Tập 6

465-478

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