Carneiro Arie, Sivaraman Arjun, Sanchez-Salas Rafael, Di Trapani Ettore, Barret Eric, Rozet Francois, Galiano Marc, Pizzaro Facundo Uriburu, Doizi Steeve, Cathala Nathalie, Mombet Annick, Prapotnich Dominique, Cathelineau Xavier
Department of Urology, Institute Mutualiste Montsouris, 42, Boulevard Jourdan, 75674, Paris Cedex 14, France.
World J Urol. 2015 Dec;33(12):2039-44. doi: 10.1007/s00345-015-1552-1. Epub 2015 Apr 14.
To evaluate the transition from laparoscopic (LPN) to robotic partial nephrectomy (RPN) in our institution using 'trifecta' outcomes as surrogate marker of efficacy.
We identified 347 patients (LPN = 303, RPN = 44) in our prospectively maintained PN database between 2000 and 2014. The patients were chronologically divided into G1-first 151 LPN cases, G2-subsequent 152 LPN cases and G3-all RPN patients. Trifecta outcomes were defined as warm ischemia time (WIT) ≤25 min, no positive surgical margin (PSM) and complications ≤Clavien 2. Multivariable logistic model was used to analyze the predictors of the trifecta outcomes.
The tumor complexity significantly increased from G1 to G3. We achieved lower WIT and less high-grade complication (Clavien ≥ 3) from G1 to G2, and the trend continued even with transition to RPN. PSM was consistently low throughout the transition. Renal functional outcomes always showed a significant positive trend, and with RPN, we achieved improved recovery of renal function (44 vs 57 vs 82 %, p < 0.05). The overall 'trifecta' rates increased significantly from G1 to G2 and reached 81.8 % in RPN (48 vs 75.6 vs 81 %, p < 0.01). Multivariate analysis has shown that the use of robot has significant effect on achieving overall trifecta. The limitations of the study are being retrospective and non-randomized, and the trifecta definitions were not externally validated.
Our transition to RPN was essentially a continuation of our previous LPN experience as we continue to achieve higher 'trifecta' rates inspite of increasing tumor complexity.
在我们机构中，以“三连胜”结果作为疗效替代指标，评估从腹腔镜部分肾切除术（LPN）向机器人辅助部分肾切除术（RPN）的转变。
我们在2000年至2014年期间前瞻性维护的肾部分切除术数据库中识别出347例患者（LPN = 303例，RPN = 44例）。患者按时间顺序分为G1组（前151例LPN病例）、G2组（随后的152例LPN病例）和G3组（所有RPN患者）。“三连胜”结果定义为热缺血时间（WIT）≤25分钟、无手术切缘阳性（PSM）且并发症≤Clavien 2级。采用多变量逻辑模型分析“三连胜”结果的预测因素。
从G1组到G３组，肿瘤复杂性显著增加。从G1组到G2组，我们实现了更低的WIT和更少的高级别并发症（Clavien≥3级），即使向RPN转变，这一趋势仍在持续。在整个转变过程中，PSM一直很低。肾功能结果始终呈现显著的正向趋势，采用RPN时，我们实现了肾功能的更好恢复（44%对57%对82%，p<0.05）。总体“三连胜”率从G1组到G2组显著增加，在RPN组达到81.8%（48%对75.6%对81%，p<0.01）。多变量分析表明，使用机器人对实现总体“三连胜”有显著影响。本研究的局限性在于为回顾性且非随机，并且“三连胜”定义未经过外部验证。
我们向RPN的转变本质上是我们先前LPN经验的延续，尽管肿瘤复杂性增加，但我们仍继续实现更高的“三连胜”率。
