Department of Urology and Renal Transplantation, Martin-Luther-University, Halle/Saale, Germany.
BJU Int. 2014 Feb;113(2):266-74. doi: 10.1111/bju.12376. Epub 2013 Nov 25.
To report on a large multi-institutional series of laparoendoscopic single-site (LESS) partial nephrectomy (PN) and analyse renal function and short-term oncological outcomes.
We conducted a retrospective analysis of consecutive cases of LESS-PN performed between November 2007 and March 2012 at 11 participating institutions. Demographic data and data on the main peri-operative outcomes and complications were gathered and analysed. Kidney function was evaluated by measuring serum creatinine concentration and estimated glomerular filtration rate (eGFR). Chronic kidney disease was defined in stages for each patient according to the National Kidney Foundation, Kidney Disease Outcomes Quality Initiative.
A total of 190 cases were included in this analysis. The mean renal tumour size was 2.6 cm, and the mean PADUA score was 7.2. The median operating time was 170 min with a median estimated blood loss of 150 mL. A clampless technique was used in 70 cases (36.8%) and the median warm ischaemia time (WIT) was 16.5 min. PADUA score independently predicted the length of WIT (low vs high score: odds ratio 5.11, CI 1.50-17.41, P = 0.009; intermediate vs high score: odds ratio 5.13, CI 1.56-16.88, P = 0.007). The overall postoperative complication rate was 14.7%. Where a clamping technique was used, a significant increase in serum creatinine concentration and a significant decrease in eGFR were observed postoperatively and at 6 months. On multivariate analysis PADUA score was the only predicting factor. Overall survival rates were 99, 97 and 88% at 12-, 24- and 36-month follow-up, respectively, while disease-free survival rates were 98% at 12-month and 97% at 24- and 36-month follow-up.
The study showed that LESS-PN is effective in terms of renal function preservation and oncological control at short- and intermediate-term follow-up.
报告一项大型多机构的经脐单孔腹腔镜肾部分切除术（LESS-PN）的系列病例，并分析肾功能和短期肿瘤学结果。
我们对 2007 年 11 月至 2012 年 3 月期间在 11 个参与机构进行的 LESS-PN 连续病例进行了回顾性分析。收集并分析了人口统计学数据以及主要围手术期结果和并发症的数据。通过测量血清肌酐浓度和估算肾小球滤过率（eGFR）来评估肾功能。根据美国国家肾脏基金会肾脏病结果质量倡议，为每位患者定义了慢性肾脏病的各个阶段。
本分析共纳入 190 例病例。平均肿瘤大小为 2.6cm，平均 PADUA 评分为 7.2。中位手术时间为 170 分钟，中位估计失血量为 150ml。70 例（36.8%）采用无夹闭技术，中位热缺血时间（WIT）为 16.5 分钟。PADUA 评分独立预测 WIT 长度（低 vs 高评分：比值比 5.11，95%置信区间 1.50-17.41，P=0.009；中 vs 高评分：比值比 5.13，95%置信区间 1.56-16.88，P=0.007）。总的术后并发症发生率为 14.7%。采用夹闭技术时，术后及 6 个月时血清肌酐浓度显著升高，eGFR 显著下降。多变量分析显示，PADUA 评分是唯一的预测因素。12、24 和 36 个月随访的总生存率分别为 99%、97%和 88%，12 个月随访的无病生存率为 98%，24 和 36 个月随访的无病生存率为 97%。
该研究表明，LESS-PN 在短期和中期随访中，在肾功能保护和肿瘤控制方面是有效的。
