Center for Laparoscopic and Robotic Surgery, Cleveland Clinic, Cleveland, OH, USA.
Eur Urol. 2012 May;61(5):899-904. doi: 10.1016/j.eururo.2012.01.007. Epub 2012 Jan 14.
Open partial nephrectomy (OPN) remains the gold standard for treatment of small renal masses (SRMs). Laparoscopic cryoablation (LCA) has provided encouraging outcomes. Robotic partial nephrectomy (RPN) represents a new promising option but is still under evaluation.
Compare the outcomes of RPN and LCA in the treatment of patients with SRMs.
DESIGN, SETTING, AND PARTICIPANTS: We retrospectively analyzed the medical charts of patients with SRMs (≤4cm) who underwent minimally invasive nephron-sparing surgery (RPN or LCA) in our institution from January 1998 to December 2010.
RPN and LCA.
Perioperative complications and functional and oncologic outcomes were analyzed.
A total of 446 SRMs were identified in 436 patients (RPN, n=210; LCA, n=226). Patients undergoing RPN were younger (p<0.0001), had a lower American Society of Anesthesiologists score (p<0.001), and higher baseline preoperative estimated glomerular filtration rate (eGFR) (p<0.0001). Mean tumor size was smaller in the LCA group (2.2 vs 2.4cm; p=0.004). RPN was associated with longer operative time (180 vs 165min; p=0.01), increased estimated blood loss (200 vs 75ml; p<0.0001), longer hospital stay (72 vs 48h; p<0.0001), and higher morbidity rate (20% vs 12%, p=0.015). Mean follow-ups for RPN and LCA were 4.8 mo and 44.5 mo, respectively (p<0.0001). Local recurrence rates for RPN and LCA were 0% and 11%, respectively (p<0.0001). Mean eGFR decrease after RPN and LCA was insignificant at 1 mo, at 6 mo after surgery, and during last follow-up. Limitations include retrospective study design, length of follow-up, and selection bias.
Both techniques remain viable treatment options in the management of SRMs. A higher incidence of perioperative complications was found in patients undergoing RPN. However, the technique was not predictive of the occurrence of postoperative complications. Early oncologic outcomes are promising for RPN, which also seems to be associated with better preservation of renal function. Long-term follow-up and well-designed prospective comparative studies are awaited to corroborate these findings.
开放部分肾切除术（OPN）仍然是治疗小肾肿瘤（SRMs）的金标准。腹腔镜冷冻消融术（LCA）已提供了令人鼓舞的结果。机器人部分肾切除术（RPN）代表了一种新的有前途的选择，但仍在评估中。
比较 RPN 和 LCA 治疗 SRMs 患者的结果。
设计、地点和参与者：我们回顾性分析了 1998 年 1 月至 2010 年 12 月期间在我院接受微创保肾手术（RPN 或 LCA）的 SRMs（≤4cm）患者的病历。
RPN 和 LCA。
围手术期并发症和功能及肿瘤学结果。
共确定了 436 例患者的 446 个 SRMs（RPN，n=210；LCA，n=226）。接受 RPN 的患者更年轻（p<0.0001），美国麻醉医师协会评分较低（p<0.001），基线术前估算肾小球滤过率（eGFR）较高（p<0.0001）。LCA 组的平均肿瘤大小较小（2.2 与 2.4cm；p=0.004）。RPN 与手术时间较长（180 与 165min；p=0.01）、估计失血量增加（200 与 75ml；p<0.0001）、住院时间延长（72 与 48h；p<0.0001）和更高的发病率（20%与 12%，p=0.015）有关。RPN 和 LCA 的平均随访时间分别为 4.8 个月和 44.5 个月（p<0.0001）。RPN 和 LCA 的局部复发率分别为 0%和 11%（p<0.0001）。RPN 和 LCA 术后 1 个月、术后 6 个月和末次随访时 eGFR 下降均无显著差异。局限性包括回顾性研究设计、随访时间和选择偏倚。
这两种技术仍然是治疗 SRMs 的可行治疗选择。RPN 组患者的围手术期并发症发生率较高。然而，该技术并不能预测术后并发症的发生。RPN 的早期肿瘤学结果令人鼓舞，并且似乎与更好的肾功能保护有关。需要长期随访和精心设计的前瞻性比较研究来证实这些发现。
