Department of Urology, Pitié Salpétrière, Assistance Publique - Hôpitaux de Paris, France.
BJU Int. 2013 Feb;111(2):256-63. doi: 10.1111/j.1464-410X.2012.11528.x. Epub 2012 Dec 20.
To prospectively compare the surgical and pathological outcomes obtained with robot-assisted laparoscopic partial nephrectomy (RAPN) or laparoscopic PN (LPN) for renal cell carcinoma in a multicentre cohort.
Between 2007 and 2011, 265 nephron-sparing surgeries were performed at six French urology departments. The patients underwent either RAPN (n = 220) or LPN (n = 45) procedures. The operative data included operative duration, warm ischaemia time (WIT) and estimated blood loss (EBL). The postoperative outcomes included length of stay (LOS), creatinine variation (Modification of Diet in Renal Disease group), Clavien complications and pathological results. The complexity of the renal tumour was classified using the R.E.N.A.L. nephrometry scoring system. Student's t-test and chi-squared tests were used to compare variables.
The median follow-ups for the RAPN and LPN groups were 7 and 18 months, respectively (P < 0.001). Age and American Society of Anesthesiology score were significantly higher in the LPN group (P = 0.02 and P = 0.004, respectively). These variables were lower in the RAPN group: WIT [mean (sd) 20.4 (9.7) vs 24.3 (15.2) min; P = 0.03], operative duration [mean (sd) 168.1 (55.5) vs 199.7 (51.2) min; P < 0.001], operating room occupation time [mean (sd) 248.3 (66.7) vs 278.2 (71.3) min; P = 0.008], EBL [mean (sd) 244.8 (365.4) vs 268.3 (244.9) mL; P = 0.01], use of haemostatic agents [used in 78% of RAPNs and 100% of LPNs; P < 0.001] and LOS [mean (sd) 5.5 (4.3) vs 6.8 (3.2) days; P = 0.05). There were no significant differences between pre- and postoperative creatinine levels, pathology report or complication rates between the groups. The main limitation was due to the study's non-randomised design.
RAPN is not inferior to pure LPN for perioperative outcomes (i.e. EBL, operative duration, WIT, LOS). Only a randomised study with a longer follow-up can now provide further insight into oncological outcomes.
前瞻性比较多中心队列中机器人辅助腹腔镜肾部分切除术（RAPN）与腹腔镜肾部分切除术（LPN）治疗肾细胞癌的手术和病理结果。
2007 年至 2011 年，6 家法国泌尿科共进行了 265 例保肾手术。患者接受 RAPN（n=220）或 LPN（n=45）手术。手术数据包括手术时间、热缺血时间（WIT）和估计失血量（EBL）。术后结果包括住院时间（LOS）、肌酐变化（肾脏病膳食改良试验组）、Clavien 并发症和病理结果。采用 R.E.N.A.L. 肾肿瘤评分系统对肾肿瘤的复杂性进行分类。采用 Student's t 检验和卡方检验比较变量。
RAPN 和 LPN 组的中位随访时间分别为 7 个月和 18 个月（P<0.001）。LPN 组患者年龄和美国麻醉医师协会评分显著较高（P=0.02 和 P=0.004）。RAPN 组患者的 WIT[平均值（标准差）20.4（9.7）vs 24.3（15.2）min；P=0.03]、手术时间[平均值（标准差）168.1（55.5）vs 199.7（51.2）min；P<0.001]、手术室占用时间[平均值（标准差）248.3（66.7）vs 278.2（71.3）min；P=0.008]、EBL[平均值（标准差）244.8（365.4）vs 268.3（244.9）mL；P=0.01]、止血剂的使用[RAPN 组 78%，LPN 组 100%；P<0.001]和 LOS[平均值（标准差）5.5（4.3）vs 6.8（3.2）天；P=0.05]均较低。两组患者术前和术后肌酐水平、病理报告或并发症发生率无显著差异。主要局限性在于研究的非随机设计。
RAPN 在围手术期结果（即 EBL、手术时间、WIT、LOS）方面并不逊于纯 LPN。只有更长时间的随访才能通过随机研究提供对肿瘤学结果的进一步了解。
