Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Eur Urol. 2012 Mar;61(3):593-9. doi: 10.1016/j.eururo.2011.11.040. Epub 2011 Dec 2.
Indications for partial nephrectomy (PN) in the treatment of renal cell carcinoma are evolving, particularly for larger, more complex tumors.
Compare single-institution outcomes for minimally invasive partial nephrectomy (MIPN) and open partial nephrectomy (OPN) for tumors>4-7 cm.
DESIGN, SETTING, AND PARTICIPANTS: A total of 2290 patients underwent PN from 2002 to 2010 at Memorial Sloan-Kettering Cancer Center; 280 had >4-7 cm renal cortical tumors. Of these 280 patients, 230 had pT1b, 48 had pT3a, and 2 had angiomyolipomas; 226 underwent OPN and 54 underwent MIPN (16 robot-assisted and 37 laparoscopic procedures). Perioperative management was uniform on the clinical pathway. Perioperative data, clinicopathologic variables, complications within 30 d, and oncologic outcomes were reviewed.
Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Complications were reported from prospectively collected data based on a modified Clavien system. The Fisher exact and Mann-Whitney U tests were used for descriptive statistical analysis. Kaplan-Meier methods were used to estimate survival.
Median follow-up for OPN and MIPN was 29 and 13 mo, respectively. There were no statistically significant differences in age, gender, preoperative American Society of Anesthesiologists score, laterality, histologic subtype, tumor size, tumor stage, or margin status between procedures. Univariate analysis revealed significantly greater values in the OPN group for preoperative eGFR, renal artery clamp time, estimated blood loss, use of renal hypothermia, and length of stay. Differences in overall survival and recurrence-free survival were not statistically significant; however, short median follow-up times limit comparison. There was no significant difference in the number of complications grade≥3 (p=0.1) or urine leaks requiring intervention (p=0.7). Limitations include the retrospective nature of the study and the possibility of selection bias.
OPN and MIPN procedures performed in patients with tumors>4-7 cm offer acceptable and comparable results in terms of operative, functional, and convalescence measures, regardless of approach.
部分肾切除术（PN）治疗肾细胞癌的适应证正在不断发展，特别是对于较大、较复杂的肿瘤。
比较微创部分肾切除术（MIPN）和开放性部分肾切除术（OPN）治疗>4-7cm 肿瘤的单中心结果。
设计、地点和参与者：2002 年至 2010 年，共有 2290 例患者在纪念斯隆-凯特琳癌症中心接受 PN 治疗；280 例患者有>4-7cm 的肾皮质肿瘤。在这 280 例患者中，230 例为 pT1b，48 例为 pT3a，2 例为血管平滑肌脂肪瘤；226 例行 OPN，54 例行 MIPN（16 例机器人辅助，37 例腹腔镜）。临床路径上采用了统一的围手术期管理。回顾了围手术期数据、临床病理变量、30 天内并发症和肿瘤学结果。
采用慢性肾脏病流行病学合作组方程计算估算肾小球滤过率（eGFR）。并发症根据改良的 Clavien 系统从前瞻性收集的数据中报告。采用 Fisher 精确检验和 Mann-Whitney U 检验进行描述性统计分析。Kaplan-Meier 方法用于估计生存。
OPN 和 MIPN 的中位随访时间分别为 29 个月和 13 个月。两种手术在年龄、性别、术前美国麻醉医师协会评分、侧别、组织学亚型、肿瘤大小、肿瘤分期或切缘状态方面无统计学差异。单因素分析显示，OPN 组术前 eGFR、肾动脉夹闭时间、估计失血量、使用肾低温和住院时间均有显著升高。总生存和无复发生存的差异无统计学意义；然而，较短的中位随访时间限制了比较。≥3 级并发症的数量（p=0.1）或需要干预的尿漏（p=0.7）无显著差异。局限性包括研究的回顾性和选择偏倚的可能性。
对于>4-7cm 的肿瘤，OPN 和 MIPN 手术在手术、功能和恢复方面提供了可接受和可比的结果，无论采用何种方法。
