Hadjipavlou Marios, Khan Fahd, Fowler Sarah, Joyce Adrian, Keeley Francis X, Sriprasad Seshadri
Department of Urology, Darent Valley Hospital, Dartford, Kent, UK.
British Association of Urological Surgeons, London, UK.
BJU Int. 2016 Jan;117(1):62-71. doi: 10.1111/bju.13114. Epub 2015 May 13.
To analyse and compare data from the British Association of Urological Surgeons Nephrectomy Audit for perioperative outcomes of partial (PN) and radical nephrectomy (RN) for T1 renal tumours.
UK consultants were invited to submit data on all patients undergoing nephrectomy between 1 January and 31 December 2012 to a nationally established database using a standard pro forma. Analysis was made on patient demographics, operative technique, and perioperative data/outcome between PN and RN for T1 tumours.
Overall, data from 6 042 nephrectomies were reported of which 1 768 were performed for T1 renal tumours. Of these, 1 082 (61.2%) were RNs and 686 (38.8%) were PNs. The mean age of patients undergoing PN was lower (PN 59 years vs RN 64 years; P < 0.001) and so was the WHO performance score (PN 0.4 vs RN 0.7; P < 0.001). PN for the treatment of T1a tumours (≤4 cm) accounted for 55.6% of procedures, of which 43.9% were performed using a minimally invasive technique. For T1b tumours (4-7 cm), 18.9% of patients underwent PN, in 33.3% of which a minimally invasive technique was adopted. The vast majority of RNs for T1 tumours were performed using a minimally invasive technique (90.3%). Of the laparoscopic PNs, 30.5% were robot-assisted. There was no significant difference in overall intraoperative complications between the RN and PN groups (4% vs 4.3%; P = 0.79). However, PN accounted for a higher overall postoperative complications rate (RN 11.3% vs PN 17.6%; P < 0.001). RN was associated with a markedly reduced risk of severe surgical complications (Clavien Dindo classification grade ≥3) compared with PN even after adjusting for technique (odds ratio 0.30; P = 0.002). Operation time between RN and PN was comparable (141 vs 145 min; P = 0.25). Blood loss was less in the RN group (mean for RN 165 vs PN 323 mL; P < 0.001); however, transfusion rates were similar (3.2% vs 2.6%; P = 0.47). RN was associated with a shorter length of stay (median 4 vs 5 days; P < 0.001). A direct comparison between robot-assisted and laparoscopic PN showed no significant differences in operation time, blood loss, warm ischaemia time, and intraoperative and postoperative complications.
PN was the method of choice for treatment of T1a tumours whereas RN was preferred for T1b tumours. Minimally invasive techniques have been widely adopted for RN but not for PN. Despite the advances in surgical technique, a substantial risk of postoperative complications remains with PN.
分析并比较英国泌尿外科医师协会肾切除术审计中T1期肾肿瘤行部分肾切除术（PN）和根治性肾切除术（RN）的围手术期结果。
邀请英国的会诊医师使用标准表格，将2012年1月1日至12月31日期间所有接受肾切除术患者的数据提交至一个全国性数据库。对T1期肿瘤行PN和RN患者的人口统计学资料、手术技术及围手术期数据/结果进行分析。
总体而言，共报告了6042例肾切除术的数据，其中1768例为T1期肾肿瘤手术。其中，1082例（61.2%）为RN，686例（38.8%）为PN。接受PN的患者平均年龄较低（PN为59岁，RN为64岁；P<0.001），世界卫生组织体能状态评分也较低（PN为0.4，RN为0.7；P<0.001）。治疗T1a期肿瘤（≤4cm）的PN占手术的55.6%，其中43.9%采用微创技术。对于T1b期肿瘤（4～7cm），18.9%的患者接受了PN，其中33.3%采用了微创技术。T1期肿瘤的绝大多数RN采用微创技术（90.3%）。在腹腔镜PN中，30.5%为机器人辅助手术。RN组和PN组总体术中并发症无显著差异（4%对4.3%；P=0.79）。然而，PN的总体术后并发症发生率较高（RN为11.3%，PN为17.6%；P<0.001）。即使在调整技术因素后，与PN相比，RN发生严重手术并发症（Clavien Dindo分级≥3级）的风险也显著降低（优势比0.30；P=0.002）。RN和PN的手术时间相当（141对145分钟；P=0.25）。RN组的失血量较少（RN平均为165ml，PN为323ml；P<0.001）；然而，输血率相似（3.2%对2.6%；P=0.47）。RN与住院时间较短相关（中位数分别为4天和5天；P<0.001）。机器人辅助PN和腹腔镜PN的直接比较显示，手术时间、失血量、热缺血时间以及术中及术后并发症方面无显著差异。
PN是治疗T1a期肿瘤的首选方法，而RN更适用于T1b期肿瘤。微创技术已在RN中广泛应用，但PN未广泛应用。尽管手术技术有所进步，但PN术后仍存在较高的并发症风险。
