Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Hospital St-Luc, 1058, rue St-Denis, Montreal, Quebec, Canada H2X 3J4.
Eur J Surg Oncol. 2012 Jan;38(1):80-7. doi: 10.1016/j.ejso.2011.09.035. Epub 2011 Oct 13.
To examine the use of open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN), as well as intraoperative and postoperative morbidity.
A retrospective cohort analysis of the Nationwide Inpatient Sample for years 1998-2007. Patients with non-metastatic kidney cancer who underwent OPN or LPN were identified. Propensity-based matching was performed to adjust for potential baseline differences between the two groups. The rates of intraoperative and postoperative complications, blood transfusions, length of stay, and in-hospital mortality were assessed for both procedures.
Overall, 7990 (93.9%) and 523 (6.1%) patients underwent OPN and LPN, respectively. Use of LPN increased 19-fold over the study period (P < 0.001). For OPN and LPN respectively, the following rates were recorded: blood transfusions, 9.3 vs. 3.8% (P < 0.001); intraoperative complications, 2.9 vs. 1.5% (P = 0.06); postoperative complications, 15.4 vs. 11.3% (P = 0.01); length of stay ≥5 days, 46.7 vs. 20.8% (P < 0.001); in-hospital mortality, 0.4 vs. 0.4% (P = 0.98). In multivariable logistic regression analyses, LPN patients were less likely to have a blood transfusion (odds ratio [OR]: 0.40, P < 0.001), to experience any postoperative complication (OR: 0.74, P = 0.03), and to be hospitalized for more than 5 days (OR: 0.32, P < 0.001). Post-propensity score matched analyses revealed virtually the same results.
After adjustment for potential selection biases, LPN is associated with fewer adverse outcomes than OPN. However, the current results should be interpreted with caution, given the lack of tumor characteristics. Furthermore, statistical adjustment is not a substitute for a needed randomized trial.
本研究旨在探讨开放式部分肾切除术（OPN）和腹腔镜部分肾切除术（LPN）的应用，并分析围手术期并发症和术后发病率。
采用回顾性队列分析方法，对 1998 年至 2007 年全国住院患者样本进行研究。入选标准为非转移性肾癌患者，接受 OPN 或 LPN 治疗。采用倾向评分匹配法调整两组患者的基线差异。评估两种手术的术中及术后并发症、输血率、住院时间和院内死亡率。
共有 7990 例（93.9%）患者接受 OPN 治疗，523 例（6.1%）患者接受 LPN 治疗。研究期间 LPN 的使用率增加了 19 倍（P<0.001）。OPN 和 LPN 组的输血率分别为 9.3%和 3.8%（P<0.001）；术中并发症发生率分别为 2.9%和 1.5%（P=0.06）；术后并发症发生率分别为 15.4%和 11.3%（P=0.01）；住院时间≥5 天的比例分别为 46.7%和 20.8%（P<0.001）；院内死亡率分别为 0.4%和 0.4%（P=0.98）。多变量逻辑回归分析显示，LPN 组患者输血的可能性较小（比值比[OR]：0.40，P<0.001），发生任何术后并发症的可能性较小（OR：0.74，P=0.03），住院时间超过 5 天的可能性较小（OR：0.32，P<0.001）。倾向评分匹配后分析得到了几乎相同的结果。
在调整了潜在的选择偏倚后，LPN 与 OPN 相比，不良结局发生的风险较低。然而，鉴于缺乏肿瘤特征，目前的结果应谨慎解释。此外，统计调整不能替代必要的随机试验。
