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 T1N 0M 0 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.