Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Jpn J Clin Oncol. 2012 Jul;42(7):619-24. doi: 10.1093/jjco/hys061. Epub 2012 May 4.
The aims of the present study were to evaluate the effect of body mass index on the surgical outcomes of open partial nephrectomy and laparoscopic partial nephrectomy, and to analyze whether higher body mass index patients may derive greater benefit from laparoscopic partial nephrectomy.
We reviewed 110 patients who underwent open partial nephrectomy and 47 patients who underwent laparoscopic partial nephrectomy at our institution. We analyzed the data to determine what kind of factor would be associated with prolonged operative time, increased estimated blood loss and prolonged ischemic time, and compared the result of open partial nephrectomy with that of laparoscopic partial nephrectomy.
A statistically significant correlation was observed between body mass index and operative time or estimated blood loss in open partial nephrectomy. Multivariate analysis also demonstrated that body mass index was an independent predictor for prolonged operative time and higher estimated blood loss in open partial nephrectomy, but not in laparoscopic partial nephrectomy. In the normal body mass index group (body mass index<25.0 kg/m2), although mean operative time in the laparoscopic partial nephrectomy group was significantly longer than that in the open partial nephrectomy group, the difference was relatively small. In the high body mass index group (body mass index≥25.0 kg/m2), the mean operative time of the two groups was not statistically different. The estimated blood loss of open partial nephrectomy was significantly higher than that of laparoscopic partial nephrectomy in both groups. In both operative procedures, tumor size was an independent predictor for prolonged ischemic time in multivariate analysis.
Body mass index was an independent predictor for prolonged operative time and higher estimated blood loss in open partial nephrectomy but not in laparoscopic partial nephrectomy. Laparoscopic partial nephrectomy was less influenced by body mass index and had a greater benefit, especially in high body mass index patients.
本研究旨在评估体重指数（BMI）对开放肾部分切除术和腹腔镜肾部分切除术手术结果的影响，并分析高 BMI 患者是否可能从腹腔镜肾部分切除术获得更大益处。
我们回顾了在我院行开放肾部分切除术的 110 例患者和行腹腔镜肾部分切除术的 47 例患者。我们分析了数据，以确定哪些因素与手术时间延长、估计失血量增加和缺血时间延长有关，并比较了开放肾部分切除术与腹腔镜肾部分切除术的结果。
在开放肾部分切除术中，BMI 与手术时间或估计失血量呈显著正相关。多变量分析还表明，BMI 是开放肾部分切除术手术时间延长和估计失血量增加的独立预测因素，但不是腹腔镜肾部分切除术的独立预测因素。在正常 BMI 组（BMI<25.0 kg/m2），尽管腹腔镜肾部分切除术组的平均手术时间明显长于开放肾部分切除术组，但差异相对较小。在高 BMI 组（BMI≥25.0 kg/m2），两组的平均手术时间无统计学差异。两组中，开放肾部分切除术的估计失血量明显高于腹腔镜肾部分切除术。在两种手术中，肿瘤大小是多变量分析中缺血时间延长的独立预测因素。
BMI 是开放肾部分切除术手术时间延长和估计失血量增加的独立预测因素，但不是腹腔镜肾部分切除术的独立预测因素。腹腔镜肾部分切除术受 BMI 的影响较小，且获益更大，尤其是在高 BMI 患者中。
