USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
J Urol. 2010 Jan;183(1):34-41. doi: 10.1016/j.juro.2009.08.114.
We hypothesized that from 1999 to 2008 patient and tumor selection criteria, perioperative outcomes, complications and renal function outcomes may have evolved significantly in 800 laparoscopic partial nephrectomies.
We retrospectively divided 800 patients who underwent laparoscopic partial nephrectomy for tumor, as done by 1 surgeon, into 3 chronologic eras, including era 1-276 from September 1999 to December 2003, era 2-289 from January 2004 to December 2006 and era 3-235 from January 2007 through November 2008. We evaluated prospectively collected data on tumor characteristics, perioperative outcomes and renal function outcomes.
When comparing eras 1 to 3, tumors in the most recent era were larger, more commonly 4 cm or greater, and central, and less often peripheral and less than 4 cm (each p value significant). Despite increasing tumor complexity warm ischemia time was shorter (31.9, 31.6 and 14.4 minutes, respectively, p <0.0001), and the overall rates of postoperative and urological complications were significantly lower in the most recent era. The rate of parenchymal margins positive for cancer was 1%, 1% and 0.6%, respectively. Renal function outcomes were superior in era 3, as reflected by a lesser decrease in the estimated glomerular filtration rate (18%, 20% and 11%, respectively). In the 744 patients with pathologically confirmed malignancy 5-year overall, cancer specific and recurrence-free survival was 90%, 99% and 97%, respectively.
During our 9-year experience with 800 consecutive laparoscopic partial nephrectomies tumor characteristics and surgical outcomes evolved. Despite increasing tumor complexity in contemporary practice 3 key outcomes of laparoscopic partial nephrectomy improved significantly, including ischemia time, complications and renal function. We now routinely offer laparoscopic partial nephrectomy for most tumors hitherto reserved for open nephron sparing surgery.
我们假设，从 1999 年到 2008 年，患者和肿瘤选择标准、围手术期结果、并发症和肾功能结果在 800 例腹腔镜部分肾切除术中有显著变化。
我们回顾性地将 800 名接受腹腔镜部分肾切除术治疗肿瘤的患者分为 3 个时间阶段，包括 1999 年 9 月至 2003 年 12 月的第 1 阶段-276 例、2004 年 1 月至 2006 年 12 月的第 2 阶段-289 例和 2007 年 1 月至 2008 年 11 月的第 3 阶段-235 例。我们评估了前瞻性收集的肿瘤特征、围手术期结果和肾功能结果的数据。
比较第 1 阶段和第 3 阶段，最近阶段的肿瘤更大，更常见的是 4cm 或更大，并且更中央，而更少的是外周和小于 4cm（每个 p 值均有意义）。尽管肿瘤复杂性增加，但热缺血时间更短（分别为 31.9、31.6 和 14.4 分钟，p <0.0001），最近阶段的术后和泌尿科并发症总体发生率显著降低。癌症阳性切缘的比例分别为 1%、1%和 0.6%。肾功能结果在第 3 阶段更好，反映在估算肾小球滤过率的下降较少（分别为 18%、20%和 11%）。在 744 例病理证实为恶性肿瘤的患者中，5 年的总体生存率、癌症特异性生存率和无复发生存率分别为 90%、99%和 97%。
在我们 9 年的 800 例连续腹腔镜部分肾切除术经验中，肿瘤特征和手术结果发生了变化。尽管当代实践中肿瘤复杂性增加，但腹腔镜部分肾切除术的 3 个关键结果显著改善，包括缺血时间、并发症和肾功能。我们现在常规为大多数以前保留开放保肾手术的肿瘤提供腹腔镜部分肾切除术。
