Department of Urology, 'San Luigi Gonzaga' Hospital - Orbassano (Turin), University of Turin, Turin, Italy.
BJU Int. 2013 Dec;112(8):1125-32. doi: 10.1111/bju.12317. Epub 2013 Aug 13.
To present our laparoscopic partial nephrectomy (LPN) results according to the margin, ischaemia and complications (MIC) system recently proposed for the standardized reporting of partial nephrectomy (PN) outcomes. To assess the role of learning curve and tumour anatomical characteristics on the outcomes by using MIC system.
Data were obtained from our prospectively maintained LPN database, including only patients who underwent LPN performed with vascular clamping. According to the MIC system definition, the goal of LPN was reached (i.e. MIC was achieved) when surgical margins were negative, warm ischaemia time (WIT) was <20 min and no major complications occurred. Patients were stratified by quartiles of distribution, named LPN eras 1-4, and MIC rates in different LPN eras were compared, evaluating the impact of learning curve and tumour anatomical characteristics (as assessed by Preoperative Aspects and Dimensions Used for an Anatomical [PADUA] score on the outcomes.
The study population consisted of 206 patients. The overall MIC rate was 63.1%: it progressively increased along the learning curve, reaching 84.9% in LPN era 4 (P < 0.001). PADUA-score risk group categories were inversely correlated with MIC score (P = 0.001). When simultaneously considering the effects of both LPN eras and PADUA-score risk group categories, a trend towards a higher MIC rate was found in the latest series, regardless of tumour anatomical characteristics. When MIC score components were separately analysed, WIT decreased significantly from LPN era 1 to LPN era 4 (P < 0.001) and from PADUA-score risk group categories 3 to 1 (P = 0.001) A trend towards a decrease in the complication rate along the learning curve was observed (P = 0.251), while LPN era and PADUA score together significantly influenced the complications rate (P < 0.001). The positive surgical margin rate was very low (2.9% overall) and stable throughout the case study.
The MIC rate increased with surgeon's experience and decreased when complex lesions were treated. The MIC system was found to be an easy, useful and reproducible tool to report LPN data series.
根据最近提出的用于标准化报告部分肾切除术（PN）结果的边缘、缺血和并发症（MIC）系统，介绍我们的腹腔镜部分肾切除术（LPN）结果。评估 MIC 系统中学习曲线和肿瘤解剖特征对结果的影响。
数据来自我们前瞻性维护的 LPN 数据库，仅包括接受血管夹闭的 LPN 患者。根据 MIC 系统的定义，当手术切缘为阴性、热缺血时间（WIT）<20 分钟且无严重并发症时，达到 LPN 目标（即 MIC 得到实现）。患者按分布的四分位数分层，命名为 LPN 时代 1-4，并比较不同 LPN 时代的 MIC 率，评估学习曲线和肿瘤解剖特征（如术前方面和用于解剖的维度 [PADUA] 评分）对结果的影响。
研究人群包括 206 名患者。整体 MIC 率为 63.1%：随着学习曲线的进展，MIC 率逐渐增加，在 LPN 时代 4 达到 84.9%（P < 0.001）。PADUA 评分风险组类别与 MIC 评分呈负相关（P = 0.001）。当同时考虑 LPN 时代和 PADUA 评分风险组类别的影响时，无论肿瘤解剖特征如何，最新系列中 MIC 率都呈现出更高的趋势。当单独分析 MIC 评分的组成部分时，WIT 从 LPN 时代 1 显著下降到 LPN 时代 4（P < 0.001），从 PADUA 评分风险组类别 3 下降到 1（P = 0.001）。观察到随着学习曲线的发展，并发症发生率呈下降趋势（P = 0.251），而 LPN 时代和 PADUA 评分共同显著影响并发症发生率（P < 0.001）。阳性切缘率非常低（总体为 2.9%），且在整个病例研究中保持稳定。
MIC 率随着外科医生经验的增加而增加，当处理复杂病变时则降低。MIC 系统被发现是一种简单、有用且可重复的报告 LPN 数据系列的工具。
