Objective  To investigate the feasibility, safety, and advantages of open partial nephrectomy with zero-ischemia and simultaneous resection-suture in the treatment of complex solitary renal cell carcinoma.

  Methods  We retrospectively analyzed clinical data of five patients with solitary kidneys, who underwent open partial nephrectomy with zero-ischemia and simultaneous resection-suture between October 2017 and October 2021 at Harbin Medical University Cancer Hospital. The surgeries were performed by the same surgeon. Patients’ clinical data, operation time, intraoperative blood loss, postoperative complications, postoperative oncology results, and changes of renal function were evaluated.

  Results  All five patients were successfully treated by open partial nephrectomy without any arterial occlusion; none of the interventions converted into salvage radical nephrectomy. The operation time ranged from 135–180 min and the intraoperative blood loss from 300–700 mL, with an average blood loss of 450 mL. One patient with hilar renal cell carcinoma developed a urinary fistula on postoperative day 1; however, the urinary fistula disappeared after the insertion of an indwelling F6 double "J" tube under cystoscope. The patients were followed up for 3 to 48 months, with an average follow-up time of 30.4 months. There was no local tumor recurrence in these patients, but one of them developed a costal bone metastasis a year after the operation. Compared to the preoperative values, the renal function indexes did not significantly change after operation (P>0.05).

  Conclusions  Open partial nephrectomy with zero-ischemia and simultaneous resection-suture is safe and feasible for treating tumors of solitary kidneys; especially for complex and large-sized tumors. The technique showed great advantages in protecting renal function and in oncological control.