Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Eur Urol. 2016 Jun;69(6):1149-54. doi: 10.1016/j.eururo.2015.12.004. Epub 2015 Dec 22.
Robotic partial nephrectomy (RPN) is established as a minimally invasive nephron-sparing technique with excellent perioperative and intermediate oncologic outcomes. However, long-term oncologic outcomes have not been reported to date.
To report long-term oncologic outcomes of RPN.
DESIGN, SETTING, AND PARTICIPANTS: Consecutive patients undergoing RPN from June 2006 to March 2010 were selected from our prospective RPN database. Patients with benign tumors, prior ipsilateral PN, or prior radical nephrectomy and those with follow-up of <1 mo were excluded.
Transperitoneal RPN.
Demographic, perioperative, and postoperative data were analyzed. Overall survival (OS), cancer-free survival (CFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier survival analysis. Univariate logistic regression analysis for overall mortality was performed to evaluate the odds ratio (OR) for variables of interest.
In total, 115 RPNs for RCC were performed in 110 patients. The mean age was 59.8±11.0 yr and the median age-adjusted Charlson comorbidity index (ACCI) was 4 (interquartile range [IQR] 3-5). The median tumor size was 2.6cm (IQR 2.0-3.7) and median RENAL score was 7 (IQR 6-9). Clear cell carcinoma was present in 67.8% of cases, and two cases (1.7%) had positive surgical margins. Glomerular filtration rate preservation was 87.8% (IQR 74.9-98.1), which translates to 19.1% chronic kidney disease upstaging. The median follow-up was 61.9 mo (IQR 50.9-71.4) and the 5-yr OS, CFS, and CSS were 91.1%, 97.8%, and 97.8%, respectively. On univariable logistic regression, ACCI was the only factor associated with a higher risk of overall mortality (OR 1.67, p=0.006). The retrospective design, the high surgical volume at our institution, and the potential selection bias with careful patient selection early in the RPN experience may limit the generalizability of our findings.
This is the first study confirming excellent long-term oncologic outcomes after RPN in a selected cohort of patients.
Robotic partial nephrectomy is a relatively recently developed treatment for renal cell carcinoma. This study confirms its safety and reports excellent long-term cancer control.
机器人辅助部分肾切除术（RPN）作为一种微创保肾技术，具有出色的围手术期和中期肿瘤学结果。然而，迄今为止尚未报告长期肿瘤学结果。
报告 RPN 的长期肿瘤学结果。
设计、地点和参与者：从我们的前瞻性 RPN 数据库中选择了 2006 年 6 月至 2010 年 3 月期间连续接受 RPN 的患者。排除良性肿瘤、同侧 PN 既往史或根治性肾切除术病史以及随访时间<1 个月的患者。
经腹腔 RPN。
分析了人口统计学、围手术期和术后数据。使用 Kaplan-Meier 生存分析评估总生存率（OS）、无癌生存率（CFS）和癌症特异性生存率（CSS）。进行单变量逻辑回归分析以评估整体死亡率的优势比（OR），以评估感兴趣变量的 OR。
共对 110 例患者的 115 例 RCC 行 RPN。平均年龄为 59.8±11.0 岁，年龄调整后的 Charlson 合并症指数（ACCI）中位数为 4（四分位距 [IQR] 3-5）。中位肿瘤大小为 2.6cm（IQR 2.0-3.7），中位 RENAL 评分 7（IQR 6-9）。67.8%的病例为透明细胞癌，2 例（1.7%）有阳性手术切缘。肾小球滤过率保留率为 87.8%（IQR 74.9-98.1），这导致 19.1%的慢性肾脏病分期升高。中位随访时间为 61.9 个月（IQR 50.9-71.4），5 年 OS、CFS 和 CSS 分别为 91.1%、97.8%和 97.8%。在单变量逻辑回归中，ACCI 是与整体死亡率升高相关的唯一因素（OR 1.67，p=0.006）。回顾性设计、我们机构的高手术量以及在 RPN 早期经验中仔细选择患者可能存在的选择偏倚，可能限制了我们研究结果的普遍性。
这是第一项在选定患者队列中证实 RPN 后具有出色长期肿瘤学结果的研究。
机器人辅助部分肾切除术是治疗肾细胞癌的一种相对较新的治疗方法。本研究证实了其安全性，并报告了出色的长期癌症控制结果。
