Raman Jay D, Smith Benjamin, Messer Jamie, Rohner Thomas J, Harpster Lewis E, Reese Carl T
Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033-0850, USA.
Can J Urol. 2011 Oct;18(5):5896-902.
To evaluate preoperative parameters of patients undergoing partial nephrectomy to determine variables that impact selection of operative approach.
The charts of 229 consecutive patients undergoing partial nephrectomy were reviewed. Clinical data points and associated axial imaging were evaluated to determine factors which contributed to selection of an open (versus laparoscopic) operation.
A total of 140 men and 89 women with a mean age of 57 years, body mass index (BMI) of 31, and glomerular filtration rate (GFR) of 82 mL/min/1.73 m(2) were included. Twenty-three percent of patients had prior abdominal surgery and 7% had a history of contralateral renal cell carcinoma (RCC). The mean tumor size was 3.4 cm (range, 0.7-11) with 23% of lesions being endophytic, 38% involving the collecting system, and 29% being hilar. Thirty-four patients (15%) had multifocal lesions. Overall, 130 patients underwent an open partial nephrectomy (OPN) and 99 a laparoscopic partial nephrectomy (LPN). On univariate analysis, preoperative GFR (p = 0.05), a history of contralateral RCC surgery (p = 0.02), tumor size (p = 0.04), renal sinus/collecting system involvement (p = 0.001), renal hilar location (p = 0.001), tumor multifocality (p = 0.004), surgeon laparoscopic case volume of <25 cases (p = 0.03), and lack of fellowship laparoscopic training (p = 0.02) all were associated with an open surgical approach. In a logistic regression model incorporating these eight variables, only renal hilar location (OR 2.63, 95% CI 1.17-5.88, p = 0.02) remained significantly associated with OPN.
Many parameters including increasing BMI, preoperative GFR, prior abdominal surgery, endophytic tumor location, and renal sinus/collecting system involvement do not necessarily preclude a minimally invasive partial nephrectomy. In our experience, renal hilar tumors were over 2.5 fold more likely to be managed by OPN owing to the complexity of resection.
评估接受部分肾切除术患者的术前参数，以确定影响手术方式选择的变量。
回顾了229例连续接受部分肾切除术患者的病历。评估临床数据点及相关的轴向成像，以确定有助于选择开放（对比腹腔镜）手术的因素。
共纳入140例男性和89例女性，平均年龄57岁，体重指数（BMI）为31，肾小球滤过率（GFR）为82 mL/min/1.73 m²。23%的患者曾有腹部手术史，7%有对侧肾细胞癌（RCC）病史。平均肿瘤大小为3.4 cm（范围0.7 - 11 cm），23%的病灶为内生性，38%累及集合系统，29%位于肾门部。34例患者（15%）有多发病灶。总体而言，130例患者接受了开放性部分肾切除术（OPN），99例接受了腹腔镜部分肾切除术（LPN）。单因素分析显示，术前GFR（p = 0.05）、对侧RCC手术史（p = 0.02）、肿瘤大小（p = 0.04）、肾窦/集合系统受累（p = 0.001）、肾门位置（p = 0.001）、肿瘤多灶性（p = 0.004）、外科医生腹腔镜手术量<25例（p = 0.03）以及缺乏腹腔镜 fellowship 培训（p = ）均与开放手术方式相关。在纳入这八个变量的逻辑回归模型中，仅肾门位置（OR 2.63，95% CI 1.17 - 5.88，p = 0.02）仍与OPN显著相关。
许多参数，包括BMI增加、术前GFR、既往腹部手术、内生性肿瘤位置以及肾窦/集合系统受累，不一定排除微创部分肾切除术。根据我们的经验，由于切除的复杂性，肾门部肿瘤接受OPN治疗的可能性超过2.5倍。
