Zargar Homayoun, Bhayani Sam, Allaf Mohamad E, Stifelman Michael, Rogers Craig, Larson Jeffrey, Ball Mark W, Marshall Susan, Kumar Ramesh, Fergany Amr, Campbell Steven, Kaouk Jihad
1 Glickman Urological and Kidney Institute, Cleveland Clinic , Cleveland, Ohio.
J Endourol. 2014 Oct;28(10):1224-30. doi: 10.1089/end.2014.0297. Epub 2014 Jul 28.
To compare the perioperative outcomes of robot-assisted partial nephrectomy (RAPN) with open partial nephrectomy (OPN) in solitary kidneys.
Records of 1542 consecutive RAPN performed in five high-volume centers (2007-2013) were reviewed for patients with solitary kidneys. RESULTS were compared with solitary OPN cases performed during the same period. Cases were divided into simple (R.E.N.A.L. nephrometry score 4-8) and complex (R.E.N.A.L. 9-12) groups. Demographics, surgical, pathologic, and follow-up data were compared between OPN and RAPN in each group.
40 RAPN and 85 OPN cases were identified. For both tumor complexity groups, patients in each treatment modality were comparable. There were higher proportions of OPN cases in the complex group (61.2% vs 25%; P=0.001). For both complexity tumor groups, there was no statistical difference between the treatment modalities in overall intraoperative/postoperative complications, transfusion rate, and positive surgical margin (PSM) rates. Patients in the RAPN group had a shorter length of hospital stay. For the entire cohort, there was no difference in estimated glomerular filtration rate preservation beyond 1 month (OPN 80.51%, RAPN 81.29%). Limitations include retrospective, nonrandomized nature of the series and small number of cases in the RAPN groups.
In the solitary kidney, RAPN offers comparable perioperative and short-term functional outcomes for localized tumors with low R.E.N.A.L. score. For more complex tumors, our early experience suggests comparability, but these results were obtained in selected cases and future studies will need to validate these results.
比较机器人辅助肾部分切除术（RAPN）与开放性肾部分切除术（OPN）治疗孤立肾的围手术期结果。
回顾了五个高容量中心（2007 - 2013年）连续进行的1542例RAPN手术记录，纳入孤立肾患者。将结果与同期进行的孤立肾OPN病例进行比较。病例分为简单组（R.E.N.A.L.肾计量评分4 - 8分）和复杂组（R.E.N.A.L. 9 - 12分）。比较每组中OPN和RAPN之间的人口统计学、手术、病理及随访数据。
共确定40例RAPN病例和85例OPN病例。对于两个肿瘤复杂程度组，每种治疗方式的患者具有可比性。复杂组中OPN病例的比例更高（61.2%对25%；P = 0.001）。对于两个肿瘤复杂程度组，在总体术中和术后并发症、输血率及手术切缘阳性（PSM）率方面，两种治疗方式之间无统计学差异。RAPN组患者的住院时间较短。对于整个队列，1个月后估计肾小球滤过率的保留情况无差异（OPN为80.51%，RAPN为81.29%）。局限性包括该系列研究的回顾性、非随机性质以及RAPN组病例数量较少。
对于孤立肾且R.E.N.A.L.评分低的局限性肿瘤，RAPN提供了可比的围手术期和短期功能结果。对于更复杂的肿瘤，我们的早期经验表明具有可比性，但这些结果是在特定病例中获得的，未来研究需要验证这些结果。
