Ricciardulli Stefano, Ding Qiang, Zhang Xu, Li Hongzhao, Tang Yuzhe, Yang Guoqiang, Wang Xiyou, Ma Xin, Breda Alberto, Celia Antonio
Department of Urology, Chinese PLA General Hospital, Beijing, China; Department of Urology, San Bassiano Hospital, Bassano Del Grappa.
Arch Ital Urol Androl. 2015 Mar 31;87(1):49-55. doi: 10.4081/aiua.2015.1.49.
To evaluate differences between Laparoscopic Partial Nephrectomy (LPN) and Robot-Assisted Partial Nephrectomy (RAPN) using the Margin, Ischemia and Complications (MIC) score system and to evaluate factors related with MIC success.
Single centre retrospective study on 258 LPN and 58 RAPN performed between January 2012 and January 2014. Success was defined when surgical margins was negative, Warm Ischemia Time (WIT) was ≤ 20 minutes and no major complications occurred. Mann-Whitney-U and Pearson χ2 correlation were used to compare LPN and RAPN. A matched pair comparison was also performed. Spearman correlation (Rho) was used to evaluate the relationship between clinical, intra and post-operative and pathological patients characteristics with MIC score. A binary regression analysis was also performed to evaluate independent factors associated with MIC success.
The MIC rate in LPN and RAPN was 55% and 65.5% respectively. No differences in clinical, intra and post-operative outcomes between groups were found. Clinical tumor size (p-value: < 0.001; OR: 0.829; 95% CI: 0.697-0.987), PADUA score (p-value: < 0.001; OR: 0.843; 95% CI: 0.740-0.960), PADUA risk groups (intermediate; p-value: < 0.001; OR: 0.416; 95% CI: 0.238- 0.792; high: p-value: < 0.001; OR: 0.356; 95% CI: 0.199- 0.636), WIT (p-value: < 0.001; OR: 0.598; 95% CI: 0.530- 0.675) were independently associated with MIC. eGFR (< 60 vs ≥ 60 ml/min per 1.73 m2: p-value: < 0.001; OR: 3.356; 95% CI: 1.701-6.621) and Fuhrman nuclear grade (p-value: 0.014; OR: 1.798; 95% CI:1.129-2.865) were also independently associated with MIC.
MIC score system is a simple and useful tool to report and to compare different surgical approach.
使用切缘、缺血和并发症（MIC）评分系统评估腹腔镜部分肾切除术（LPN）和机器人辅助部分肾切除术（RAPN）之间的差异，并评估与MIC成功相关的因素。
对2012年1月至2014年1月期间进行的258例LPN和58例RAPN进行单中心回顾性研究。当手术切缘阴性、热缺血时间（WIT）≤20分钟且未发生重大并发症时定义为成功。采用Mann-Whitney-U检验和Pearson卡方相关性分析比较LPN和RAPN。还进行了配对比较。采用Spearman相关性分析（Rho）评估临床、术中、术后及病理患者特征与MIC评分之间的关系。还进行了二元回归分析以评估与MIC成功相关的独立因素。
LPN和RAPN的MIC率分别为55%和65.5%。两组之间在临床、术中及术后结果方面未发现差异。临床肿瘤大小（p值：<0.001；OR：0.829；95%CI：0.697 - 0.987）、PADUA评分（p值：<0.001；OR：0.843；95%CI：0.740 - 0.960）、PADUA风险组（中度；p值：<0.001；OR：0.416；95%CI：0.238 - 0.792；高度；p值：<0.001；OR：0.356；95%CI：0.199 - 0.636）、WIT（p值：<0.001；OR：0.598；95%CI：0.530 - 0.675）与MIC独立相关。估算肾小球滤过率（<60 vs≥60 ml/min per 1.73 m2：p值：<0.001；OR：3.356；95%CI：1.701 - 6.621）和Fuhrman核分级（p值：0.014；OR：1.798；95%CI：1.129 - 2.865）也与MIC独立相关。
MIC评分系统是一种简单且有用的工具，可用于报告和比较不同的手术方法。
