Weinberg Aaron C, Woldu Solomon L, Wen Timothy, Deibert Christopher M, Korets Ruslan, Badani Ketan K
Department of Urology, Columbia University College of Physicians and Surgeons, New York NY, USA.
Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
Int Braz J Urol. 2015 May-Jun;41(3):473-85. doi: 10.1590/S1677-5538.IBJU.2014.0294.
To compare the utilization, perioperative complications and predictors of LCA versus RPN in the treatment of localized renal tumors.
From the Nationwide Inpatient Sample we identified patients undergoing RPN or LCA for the treatment of localized renal tumors from October 2008 through 2010. Patient and hospital-specific factors which predict postoperative complications and use of LCA were investigated.
14,275 patients with localized renal tumors were identified: 70.3% had RPN and 29.7% had LCA. LCA was more common in older patient and at hospitals without robotic consoles. No difference was identified in perioperative complications (0.2% vs. 0.2%), transfusion (5.1% vs. 6.2%), length of stay (2.9 vs. 3.0 days) or median cost ($41,753 vs. $44,618) between the groups, LCA vs. RPN. On multivariate analysis sicker patients were more likely to have LCA (OR 1.34, p=0.048) and sicker patients had greater postoperative complications (OR 3.30, p<0.001); LCA did not predict more complications (OR 1.63, p=0.138) and LCA was performed at hospitals without RCs (OR 0.02, p<0.001). Limitations include observational study design, inability to assess disease severity, operative time, or body mass index, which may affect patient selection and outcomes.
More patients had RPN vs. LCA; surgical technique was not predictive of postoperative complications. As technology develops to treat localized renal tumors, it will be important to continue to track outcomes and costs for procedures including RPN and LCA.
比较腹腔镜下肾部分切除术（LCA）与机器人辅助腹腔镜肾部分切除术（RPN）在治疗局限性肾肿瘤时的应用情况、围手术期并发症及预测因素。
从全国住院患者样本中，我们确定了2008年10月至2010年期间接受RPN或LCA治疗局限性肾肿瘤的患者。研究了预测术后并发症和LCA使用情况的患者及医院特定因素。
共确定14275例局限性肾肿瘤患者：70.3%接受RPN，29.7%接受LCA。LCA在老年患者及没有机器人控制台的医院中更常见。两组之间在围手术期并发症（0.2%对0.2%）、输血（5.1%对6.2%）、住院时间（2.9天对3.0天）或中位费用（41753美元对44618美元）方面未发现差异，即LCA组与RPN组。多因素分析显示，病情较重的患者更有可能接受LCA（比值比[OR]1.34，p = 0.048），且病情较重的患者术后并发症更多（OR 3.30，p < 0.001）；LCA并未预测更多并发症（OR 1.63，p = 0.138），且LCA在没有机器人手术设备的医院进行（OR 0.02，p < 0.001）。局限性包括观察性研究设计、无法评估疾病严重程度、手术时间或体重指数，这些可能会影响患者选择和结果。
接受RPN的患者多于LCA；手术技术并非术后并发症的预测因素。随着治疗局限性肾肿瘤技术的发展，继续跟踪包括RPN和LCA在内的手术的结果和费用将很重要。
