Department of Urology, Roswell Park Cancer Institute, Buffalo, NY 14623, USA.
J Endourol. 2012 Mar;26(3):244-8. doi: 10.1089/end.2011.0384. Epub 2012 Jan 4.
To compare operative and functional outcomes of minimally invasive partial nephrectomy (MPN) and minimally invasive radical nephrectomy (MRN) for T(1b) and T(2a) renal tumors.
All patients who underwent MPN or MRN for a localized, solitary renal mass 4 to 10 cm were included. Perioperative and renal function outcomes were compared. Propensity analysis was used to account for selection bias in type of nephrectomy when evaluating complication rates.
One hundred and eight patients underwent MRN and 45 underwent MPN between August 2004 and September 2010. Preoperative patient and tumor characteristics were similar between groups. Tumor size was larger in the MRN group (5.3 vs 6.8 cm, P<0.001). Operative times and positive margin rates were similar between the groups (P=0.956 and P=0.207, respectively). Estimated blood loss was higher in the MPN group (401.8 vs 157.1 mL, P<0.001), but transfusion rates were similar (P=0.225). Rates of intraoperative (P=0.724), postoperative (P=0.806), and high Clavien-grade postoperative complications (P=0.966) were similar. Propensity analysis indicated that the likelihood of any complication (odds ratio [OR] 0.810, confidence interval [CI] 0.331-1.982, P=0.645) or of a high-grade complication (OR 0.164, CI 0.011-2.513, P=0.194) was unrelated to type of nephrectomy. With similar preoperative renal function parameters, postoperative development of new stage III to V chronic kidney disease (CKD) was greater in the MRN group (58 vs 31%, P=0.011). Propensity analysis showed that the likelihood of new CKD was 2.8 times higher in the MRN group (P=0.048).
In selected patients and with appropriate surgical expertise, MPN can result in similar rates of complications but superior renal function outcomes in larger kidney tumors.
比较微创部分肾切除术（MPN）和微创根治性肾切除术（MRN）治疗 T（1b）和 T（2a）期肾肿瘤的手术和功能结果。
纳入 2004 年 8 月至 2010 年 9 月期间接受 MPN 或 MRN 治疗的局限性、孤立性肾肿块 4 至 10cm 的所有患者。比较围手术期和肾功能结果。使用倾向分析来评估并发症发生率时，考虑到肾切除术类型的选择偏倚。
108 例患者接受 MRN，45 例患者接受 MPN。两组患者术前特征和肿瘤特征相似。MRN 组肿瘤较大（5.3cm 与 6.8cm，P<0.001）。两组手术时间和阳性切缘率相似（P=0.956 和 P=0.207）。MPN 组估计出血量较高（401.8ml 与 157.1ml，P<0.001），但输血率相似（P=0.225）。术中（P=0.724）、术后（P=0.806）和高 Clavien 级术后并发症（P=0.966）发生率相似。倾向分析表明，任何并发症（比值比 [OR]0.810，置信区间 [CI]0.331-1.982，P=0.645）或高级别并发症（OR0.164，CI0.011-2.513，P=0.194）的发生与肾切除术类型无关。在具有相似术前肾功能参数的情况下，MRN 组术后新发 III 至 V 期慢性肾脏病（CKD）的发生率更高（58% 与 31%，P=0.011）。倾向分析显示，MRN 组新发 CKD 的可能性高 2.8 倍（P=0.048）。
在选择合适的患者和手术技术时，MPN 可使较大肾脏肿瘤的并发症发生率相似，但肾功能结果更好。
