Brandao Luis Felipe, Zargar Homayoun, Autorino Riccardo, Akca Oktay, Laydner Humberto, Samarasekera Dinesh, Krishnan Jayram, Haber Georges-Pascal, Stein Robert J, Kaouk Jihad H
Glickman Urological and Kidney Institute, Cleveland Clinic, OH.
Glickman Urological and Kidney Institute, Cleveland Clinic, OH.
Urology. 2014 Sep;84(3):602-8. doi: 10.1016/j.urology.2014.04.015. Epub 2014 Jun 12.
To present our robotic partial nephrectomy (RPN) experience for renal masses ≥ 7 cm and compare the surgical outcomes in this cohort with those obtained for small (≤ 4 cm) renal masses.
We retrospectively reviewed our institutional review board-approved RPN database and identified patients undergoing RPN for tumors ≥ 7 cm. Surgical technique, renal function, oncologic, and pathologic data were analyzed and compared with the RPN for renal masses ≤ 4 cm.
Overall, 441 patients were identified for the purpose of this study, including 29 cases and 412 controls. Median operative time (200 vs 180 min; P = .005), warm ischemia time (26.5 vs 19 min; P <.001), and estimated blood loss (250 mL [353] vs 150 mL [150]; P <.001) were significantly lower in the control group. Postoperative complications were significantly higher in the case group (37.9% vs 15.8%; P = .005). However, the percentages of major complications (Clavien grade ≥ III) were comparable (18.2% vs 17%; P = .57 for cases and controls respectively). Postoperative blood transfusion was higher for larger tumor group (24.1% vs 4.1%; P <.001). Positive margins were similar between groups (5.9% vs 3.3%; P = .45 for cases and controls respectively). There was no difference in estimated glomerular filtration rate decline between the two groups (12.2% vs 15.8% decline; P = .98).
RPN represents a feasible and safe nephron-sparing surgery approach for highly selected (mostly exophytic growth pattern, polar location, and likelihood of benign histology) renal masses ≥ 7 cm in diameter.
介绍我们对直径≥7 cm肾肿块行机器人辅助部分肾切除术（RPN）的经验，并将该队列的手术结果与小（≤4 cm）肾肿块的手术结果进行比较。
我们回顾性分析了经机构审查委员会批准的RPN数据库，确定了因肿瘤≥7 cm接受RPN的患者。分析手术技术、肾功能、肿瘤学和病理数据，并与直径≤4 cm肾肿块的RPN进行比较。
总体而言，本研究共纳入441例患者，包括29例病例组和412例对照组。对照组的中位手术时间（200 vs 180分钟；P = 0.005）、热缺血时间（26.5 vs 19分钟；P <0.001）和估计失血量（250 mL [353] vs 150 mL [150]；P <0.001）显著更低。病例组术后并发症显著更高（37.9% vs 15.8%；P = 0.005）。然而，严重并发症（Clavien分级≥III级）的百分比相当（分别为18.2% vs 17%；病例组和对照组P = 0.57）。较大肿瘤组术后输血率更高（24.1% vs 4.1%；P <0.001）。两组切缘阳性率相似（分别为5.9% vs 3.3%；病例组和对照组P = 0.45）。两组间估计肾小球滤过率下降无差异（下降12.2% vs 15.8%；P = 0.98）。
对于高度选择的（大多为外生性生长模式、极地位置和良性组织学可能性大）直径≥7 cm的肾肿块，RPN是一种可行且安全的保肾手术方法。
