Miyake Hideaki, Hinata Nobuyuki, Imai Satoshi, Furukawa Junya, Tanaka Kazushi, Fujisawa Masato
Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan,
Int J Clin Oncol. 2015 Aug;20(4):808-13. doi: 10.1007/s10147-015-0783-x. Epub 2015 Jan 23.
To characterize clinical advantages in robot-assisted partial nephrectomy (RAPN) for targeting renal hilar tumors, and compare them with those of open PN (OPN).
This study included 31 consecutive patients with renal hilar tumors, consisting of 15 and 16 who received OPN and RAPN, respectively, between January 2012 and May 2014. The perioperative and oncological outcomes of the two approaches were compared. In this series, a hilar tumor was defined as a renal cortical tumor located in the renal hilum that was shown, by preoperative imaging, to be in direct physical contact with the renal artery and/or vein.
There were no significant differences between demographic variables of the OPN and RAPN groups. Intended surgical procedures were successfully completed for all 31 cases. Despite lack of a significant difference between ischemia times in the two groups, operative time for RAPN was significantly longer than for OPN, and estimated blood loss during RAPN was significantly less than that during OPN. There were no significant differences between incidence of postoperative complications or percentage decrease in estimated glomerular filtration rate 4 weeks after surgery in the two groups. Indicators of postoperative recovery seemed to favor RAPN compared with OPN, with significant differences. No patient in either group was pathologically diagnosed with a positive surgical margin.
These findings suggest that, compared with OPN, RAPN is an effective, safe, and less invasive surgical option for renal hilar tumors.
为了明确机器人辅助部分肾切除术（RAPN）治疗肾门部肿瘤的临床优势，并将其与开放性部分肾切除术（OPN）的优势进行比较。
本研究纳入了31例连续的肾门部肿瘤患者，其中15例在2012年1月至2014年5月期间接受了OPN，16例接受了RAPN。比较了两种手术方式的围手术期和肿瘤学结局。在本系列研究中，肾门部肿瘤定义为位于肾门的肾皮质肿瘤，术前影像学检查显示其与肾动脉和/或静脉直接接触。
OPN组和RAPN组的人口统计学变量之间无显著差异。31例患者均成功完成了预期的手术操作。尽管两组的缺血时间无显著差异，但RAPN的手术时间明显长于OPN，且RAPN术中估计失血量明显少于OPN。两组术后并发症发生率及术后4周估计肾小球滤过率下降百分比之间无显著差异。与OPN相比，术后恢复指标似乎更有利于RAPN，差异有统计学意义。两组均无患者病理诊断为手术切缘阳性。
这些发现表明，与OPN相比，RAPN是治疗肾门部肿瘤的一种有效、安全且侵入性较小的手术选择。
