Nunez Bragayrac Luciano, Hoffmeyer Jan, Abbotoy Daniel, Attwood Kristopher, Kauffman Eric, Spiess Phillipe, Wagner Andrew, Schwaab Thomas
Department of Urology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
Otto von Guericke Universität Magdeburg, Magdeburg, Germany.
World J Urol. 2016 Dec;34(12):1651-1656. doi: 10.1007/s00345-016-1827-1. Epub 2016 Apr 15.
To analyze the functional and oncologic outcomes of minimally invasive cytoreductive nephrectomy (CN) in three high-volume cancer centers.
Three prospectively maintained, IRB-approved kidney surgery databases were queried from three high-volume cancer centers. All patients who underwent minimally invasive surgery (laparoscopic, hand-assisted laparoscopic, or robotic) partial or radical CN with existing measurable extra-renal metastatic disease between May 2001 and May of 2013 were included in this analysis.
We identified 120 patients who underwent minimally invasive CN for metastatic renal cell carcinoma. Most of the surgeries were radical (93.3 %) and performed laparoscopically (96.6 %). Median operative time was 210 min, with a median estimated blood loss of 150 cc, and 11 (9.2 %) patients received blood transfusions. Four (3.3 %) patients were converted to open surgery due to locally advanced disease and/or bleeding. Postoperative complications were seen in 28 (23.3 %) patients, of which 20 (71.4 %) were classified as minor (Clavien-Dindo I-II). The median survival of the entire cohort was 25.7 months, with a 3-year survival rate of 35 %. Multivariate analysis indicated that only hypertension, brain metastasis, and pT stage were independently associated with worse overall survival (HR > 1).
Minimally invasive cytoreductive nephrectomy is feasible and safe in experienced hands with acceptable morbidity and oncological outcomes.
分析三个大型癌症中心行微创减瘤性肾切除术（CN）的功能及肿瘤学结局。
查询了来自三个大型癌症中心的三个前瞻性维护、经机构审查委员会（IRB）批准的肾脏手术数据库。纳入2001年5月至2013年5月期间所有接受微创手术（腹腔镜、手辅助腹腔镜或机器人手术）行部分或根治性CN且存在可测量的肾外转移病灶的患者进行分析。
我们确定了120例行微创CN治疗转移性肾细胞癌的患者。大多数手术为根治性手术（93.3%），且采用腹腔镜手术（96.6%）。中位手术时间为210分钟，中位估计失血量为150毫升，11例（9.2%）患者接受了输血。4例（3.3%）患者因局部晚期疾病和/或出血转为开放手术。28例（23.3%）患者出现术后并发症，其中20例（71.4%）被归类为轻微并发症（Clavien-Dindo I-II级）。整个队列的中位生存期为25.7个月，3年生存率为35%。多变量分析表明，只有高血压、脑转移和pT分期与较差的总生存期独立相关（风险比>1）。
在经验丰富的医生手中，微创减瘤性肾切除术是可行且安全的，其发病率和肿瘤学结局均可接受。
