Ex-vivo partial nephrectomy (EPN) and renal auto-transplantation for complex renal malignancies
In April 2012, NHS Specialised Services appointed Oxford University Hospitals as the national referral centre for ex-vivo partial nephrectomy and auto-transplantation.
Background
Renal cancers in patients with a single kidney are normally managed by surgical removal (partial nephrectomy), observation or radiological destruction (ablative therapy).
A small proportion of tumours are unsuitable for these treatments, and in these circumstances patients are managed with either total removal of the kidney (radical nephrectomy) or ex-vivo partial nephrectomy and renal auto-transplantation. Patients managed with a radical nephrectomy will need long-term dialysis as a result of their treatment.
An ex-vivo partial nephrectomy (EPN) initially involves complete removal of the affected kidney. The removed kidney is then cooled on ice and fully exposed to identify the key blood vessels supplying the kidney, the ureter and any cancers within the kidney. These cancers are then cut out and the kidney repaired, following which it is transplanted back into the patient. In some patients the kidney won't work straight away and patients may need temporary dialysis. This operation offers suitable patients the possibility of long-term cancer control and avoidance of dialysis.
Our treatment outcomes
Over the past few years, we have treated numerous patients with renal carcinomas with an EPN. After nearly three years of follow-up, our patients have an overall survival rate of 75 percent and a cancer specific survival rate of 90 percent.
Patients treated with an EPN have an excellent chance of being dialysis free; as of December 2012 all our surviving patients were dialysis free. Avoidance of dialysis in patients who have had an EPN potentially has significant quality of life benefits compared to life-long dialysis.
Patient eligibility
All patients with organ-confined renal cancers in solitary functioning kidneys, or those with bilateral disease not suitable for a conventional nephron sparing treatment, are eligible for an NHS Specialised Services commissioned EPN.
EPN is not appropriate in the setting of locally advanced or metastatic disease. EPN is a major operation, and patients need to be fit enough to tolerate the surgery and the potential complications associated with it.
Referral pathway
We welcome referrals for any patient with complex T1-2 renal tumours who meet the eligibility criteria above. Every patient will be independently assessed by a urological surgeon, a cancer nurse specialist, a transplant surgeon and a nephrologist followed by an MDT discussion to assess suitability for an EPN.
Patients deemed unsuitable for an EPN will be referred back to their local hospital for a radical nephrectomy and haemodialysis.
Patients who do undergo an EPN will be followed up in Oxford for one year following surgery.
Referrals
- Mr David Cranston / Mr Mark Sullivan
Oxford Renal Surgery Group
Department of Urology
Churchill Hospital
Oxford OX3 7LE
- Email: urology.epn@ouh.nhs.uk
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