机器人辅助腹腔镜下肾部分切除术治疗大于 4cm 且高肾肿瘤评分的肿瘤：最小 1 年随访的可行性、肾功能和肿瘤学结果。
Robot-assisted laparoscopic partial nephrectomy for tumors greater than 4 cm and high nephrometry score: feasibility, renal functional, and oncological outcomes with minimum 1 year follow-up.
机构信息
Urologic Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA.
出版信息
Urol Oncol. 2013 Jan;31(1):51-6. doi: 10.1016/j.urolonc.2010.10.008. Epub 2011 Feb 2.
OBJECTIVES
Minimally invasive robotic assistance is being increasingly utilized to treat larger complex renal masses. We report on the technical feasibility and renal functional and oncologic outcomes with minimum 1 year follow-up of robot-assisted laparoscopic partial nephrectomy (RALPN) for tumors greater than 4 cm.
MATERIALS AND METHODS
The urologic oncology database was queried to identify patients treated with RALPN for tumors greater than 4 cm and a minimum follow-up of 12 months. We identified 19 RALPN on 17 patients treated between June 2007 and July 2009. Two patients underwent staged bilateral RALPN. Demographic, operative, and pathologic data were collected. Renal function was assessed by serum creatinine levels, estimated glomerular filtration rate, and nuclear renal scans assessed at baseline, 3, and 12 months postoperatively. All tumors were assigned R.E.N.A.L. nephrometry scores (http://www.nephrometry.com).
RESULTS
The median nephrometry score for the largest tumor from each kidney was 9 (range 6-11) while the median size was 5 cm (range 4.1-15). Three of 19 cases (16%) required intraoperative conversion to open partial nephrectomy. No renal units were lost. There were no statistically significant differences between preoperative and postoperative creatinine and eGFR. A statistically significant decline of ipsilateral renal scan function (49% vs. 46.5%, P = 0.006) was observed at 3 months and at 12 mo postoperatively (49% vs. 45.5%, P = 0.014). None of the patients had evidence of recurrence or metastatic disease at a median follow-up of 22 months (range 12-36).
CONCLUSIONS
RALPN is feasible for renal tumors greater than 4 cm with moderate or high nephrometry scores. Although there was a modest decline in renal function of the operated unit, RALPN may afford the ability resect challenging tumors requiring complex renal reconstruction. The renal functional and oncologic outcomes are promising at a median follow-up of 22 months, but longer follow-up is required.
目的
微创机器人辅助技术越来越多地用于治疗更大、更复杂的肾肿瘤。我们报告了机器人辅助腹腔镜肾部分切除术（RALPN）治疗大于 4cm 的肿瘤的技术可行性，以及至少 1 年的随访结果，评估了肾功能和肿瘤学结果。
材料和方法
检索泌尿外科肿瘤数据库，确定 2007 年 6 月至 2009 年 7 月间接受 RALPN 治疗且随访时间至少 12 个月的大于 4cm 的肿瘤患者。共纳入 17 名患者的 19 例 RALPN。收集患者的人口统计学、手术和病理资料。术前、术后 3 个月和 12 个月通过血清肌酐水平、估算肾小球滤过率和核肾扫描评估肾功能。所有肿瘤均采用 R.E.N.A.L. 肾脏评分系统（http://www.nephrometry.com）进行评分。
结果
最大肿瘤的肾脏每个肾脏的中位数肾脏评分（nephrometry score）为 9（范围 6-11），中位数肿瘤大小为 5cm（范围 4.1-15）。19 例中有 3 例（16%）需要术中转为开放性肾部分切除术。没有肾脏单位丢失。术前和术后肌酐和 eGFR 无统计学差异。术后 3 个月和 12 个月，对侧肾扫描功能（49%比 46.5%，P=0.006）和 12 个月（49%比 45.5%，P=0.014）均有统计学显著下降。在中位随访时间为 22 个月（范围 12-36）时，所有患者均无肿瘤复发或远处转移的证据。
结论
RALPN 对于中度或高度肾脏评分大于 4cm 的肾肿瘤是可行的。虽然手术侧肾脏单位的肾功能有适度下降，但 RALPN 可能能够切除需要复杂肾重建的具有挑战性的肿瘤。在中位随访时间为 22 个月时，肾功能和肿瘤学结果有希望，但需要更长时间的随访。
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