TITLE:
CT Appearance Following Partial Nephrectomy for Renal Cell Carcinoma Using Tissue Adhesive Bioglue
AUTHORS:
Simona Croituro, Yair Braz, Boaz Moskovitz, Ofer Nativ, Sarel Halachmi
KEYWORDS:
CT; RCC; Tissue Adhesive Bioglue
JOURNAL NAME:
Open Journal of Urology,
Vol.3 No.2,
May
15,
2013
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.