Centre Hospitalier Universitaire de Rennes, Rennes, France.
BJU Int. 2013 Aug;112(4):E283-9. doi: 10.1111/bju.12222.
To analyse the predictive factors of complications after robot-assisted laparoscopic partial nephrectomy (RALPN).
Data from six French institutions on 240 patients who underwent RALPN between 2009 and 2011 were retrospectively reviewed. Clinical (age, body mass index, American Society of Anesthesiologists and Charlson comorbidity index scores, anticoagulant treatment), tumoral (size, R.E.N.A.L nephrometry score) and operative (surgeon experience, blood loss, opening of the collecting system, operating time) variables were considered. Univariate and multivariate regression models were used to assess the impact of these variables on the occurrence of global and major postoperative complications, classified according to the Clavien system.
The median (range) patient age was 61 (26-83) years. Tumours were of low complexity in 62% of cases. Median (range) operating time, blood loss and warm ischaemia time were 161 (45-425) min, 100 (0-2500) mL and 20 (0-59) min, respectively. Postoperative complications occurred in 79 (33%) patients. Complications were ≥ grade III in 25 (10%) patients and were mostly haemorrhagic. In multivariate analysis, surgeon's experience (hazard ratio [HR]: 2.14 [1.07-4.27], P = 0.03) and blood loss (HR: 1.002 [1.001-1.003], P < 0.001) were independent predictors of overall complications. When considering major complications, opening of the collecting system was the only factor that was significant (OR: 2.99 [1.2-7.26], P = 0.02). Nephrometry R.E.N.A.L. score was not associated with postoperative complications.
In our experience, RALPN is associated with a 30% risk of postoperative complications; surgeon's experience, blood loss and opening of the collecting system were the three predictors of postoperative complications.
分析机器人辅助腹腔镜部分肾切除术（RALPN）后并发症的预测因素。
回顾 2009 年至 2011 年间，法国 6 家机构的 240 例接受 RALPN 的患者数据。临床（年龄、体重指数、美国麻醉医师协会和 Charlson 合并症指数评分、抗凝治疗）、肿瘤（大小、RENAL 肾单位评分）和手术（外科医生经验、失血量、集合系统开放、手术时间）变量均被考虑在内。使用单变量和多变量回归模型评估这些变量对全球和主要术后并发症发生的影响，根据 Clavien 系统进行分类。
患者年龄中位数（范围）为 61（26-83）岁。62%的肿瘤为低复杂性。手术时间中位数（范围）、失血量和热缺血时间分别为 161（45-425）min、100（0-2500）mL 和 20（0-59）min。79 例（33%）患者发生术后并发症。25 例（10%）并发症≥3 级，主要为出血性。多变量分析显示，外科医生的经验（风险比[HR]：2.14[1.07-4.27]，P=0.03）和失血量（HR：1.002[1.001-1.003]，P<0.001）是总体并发症的独立预测因素。当考虑主要并发症时，仅集合系统的开放是唯一显著的因素（比值比[OR]：2.99[1.2-7.26]，P=0.02）。RENAL 评分与术后并发症无关。
根据我们的经验，RALPN 术后并发症的风险为 30%；外科医生的经验、失血量和集合系统的开放是术后并发症的三个预测因素。
