The Risk Factors And Treatment Measures Of Accidental Tumor Incision During Nephron-Sparing Surgery

ObjectiveTo explore the risk factors for nephron-sparing surgery(NSS)leading to accidental tumor incision,clinical prognosis of ATI,and how to standardize treatment after ATI,to minimize tumor growth and recurrence.MethodsThe clinical data of 208 patients with renal tumor who underwent partial nephrectomy from January 2011 to January 2018 in the Department of Urology at the Second Hospital of Tianjin Medical University were retrospectively analyzed.The pathology staging was pT1N0 MO.The analysis factors were the maximum diameter of the tumor,the Fuhrman grade,the incidence of ATI during surgery,and the presence or absence of pseudocapsules in the postoperative pathology,and the positive rate of postoperative pathological margins.After excision of the tumor,ATI was simulated in vitro.We used KangJi laparoscopic disposable scissors to cut 6cases of renal nephrectomy tumor specimens,0.9% saline wash scissors,and then wash the cells washed out with acridine orange fluorescent,staining scissors and examined under a microscope.In addition,there are eight kinds of scissors on the surface: the replacement of scissors,iodophor cotton ball wipe treatment,20 W electric treatment for 3 seconds,20 W electric treatment for 5 seconds,40 W electric treatment for 3 seconds,40 W electric treatment for 5 seconds,60 W electric treatment for 3 seconds,60 W electric treatment 5 seconds.ResultsIn the 208 clinical cases,16 cases(7.69%)had accidental tumor incision during surgery.T test and χ2 test assessment showed that the largest tumor diameter(P =0.041),intraoperative arterial insufficiency(P = 0.017),cystic solid tumors(P = 0.019)and irregularly growing tumors(P = 0.035),pseudocapsule formation(P = 0.006)and multifocal focus(P = 0.011)were significantly associated with the incidence of ATI during partial nephrectomy.In vitro simulation of ATI,kidney tumor cells existed on the surface of disposable laparoscopic scissors.Iodophor swabs will not completely kill the tumor cells on the scissors.The coagulation power is 20 W and the coagulationtime is 3s.Or 5s can not effectively kill the tumor cells,but when the coagulation power reaches 40 W,and the electrocoagulation time reaches 5s,the tumor cells on the surface of the electrocoagulation disposable laparoscopic scissors can be effectively killed,and the coagulation power reaches 60 W.When the electrocoagulation time is3 s,the tumor cells on the scissors can be eliminated.ConclusionThe risk of ATI during surgery is affected by the tumor growth pattern and the nature of the tumor,and to some extent is related to the tumor size and intraoperative arterial clamping not completely.In addition,we also showed that there may be a relationship between positive ATI and margins during partial laparoscopic nephrectomy and local recurrence of postoperative tumors.In the case of ATI in the partial nephrectomy,there are many cases of renal tumor cells remaining on the surface of the laparoscopic scissors,and there may be tumor cell spillage in the damaged tumor.Although the replacement of scissors is the easiest way to avoid dissemination of tumor cells,the use of certain electrocoagulation power coagulation treatment laparoscopic scissors is also a means to effectively eliminate tumor cells remaining on the surface of the scissors,and the greater the coagulation power,the shorter the time required for electrocoagulation.In addition,we also need a comprehensive treatment of electrocoagulation of tumor lesions and sterile distilled water,so as to minimize the risk of tumor recurrence and metastasis.