Peyronnet Benoit, Seisen Thomas, Oger Emmanuel, Vaessen Christophe, Grassano Yohann, Benoit Thibaut, Carrouget Julie, Pradère Benjamin, Khene Zineddine, Giwerc Anthony, Mathieu Romain, Beauval Jean-Baptiste, Nouhaud François-Xavier, Bigot Pierre, Doumerc Nicolas, Bernhard Jean-Christophe, Mejean Arnaud, Patard Jean-Jacques, Shariat Sharokh, Roupret Morgan, Bensalah Karim
Department of Urology, Hopital Pontchaillou, CHU Rennes, Rennes, France.
Department of Urology, Hopital Pitié-Salpétrière, Paris, France.
Ann Surg Oncol. 2016 Dec;23(13):4277-4283. doi: 10.1245/s10434-016-5411-0. Epub 2016 Jul 13.
Only a few studies have compared the outcomes of robotic partial nephrectomy (RPN) and open partial nephrectomy (OPN). This study aimed to compare perioperative and oncologic outcomes of RPN and OPN.
The data of all patients who underwent partial nephrectomy from 2006 to 2014 in six academic departments of urology were retrospectively collected. Perioperative outcomes were compared between OPN and RPN patients. Cancer-specific survival (CSS) and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method and compared using the log-rank test.
The study included 1800 patients: 937 who underwent RPN and 863 who underwent OPN. The patients in the robotic group had smaller tumors (33.1 vs. 39.9 mm; p < 0.001) but comparable RENAL scores (6.8 vs. 6.7; p = 0.37). The complication rate was higher in the OPN group (28.6 vs. 18 %; p < 0.001). The OPN patients had greater estimated blood loss (359.5 vs. 275 ml; p < 0.001) and more frequent hemorrhagic complications (12.1 vs. 6.9 %; p < 0.001). The robotic approach was associated with a shorter warm ischemia time (WIT 15.7 vs. 18.6 min; p < 0.001) and a shorter hospital of stay (4.7 vs. 10.1 days; p < 0.001). In the propensity score-weighted analysis, the inverse probability of treatment weighting adjusted odds ratio for the risk of complication after OPN versus RPN was 2.11 (95 % confidence interval, 1.53-2.91; p < 0.001). After a median postoperative follow-up period of 13 months for OPN and 39 months for RPN (p < 0.001), CSS and RFS were similar in the two groups. In the multivariate analysis, RPN showed an impact on the occurrence of a complication but had no effect on WIT or RFS.
In this study, RPN was less morbid than OPN, with lower complications, less blood loss, and a shorter hospital of stay. The intermediate-term oncologic outcomes were similar in the two groups.
仅有少数研究比较了机器人辅助部分肾切除术（RPN）和开放性部分肾切除术（OPN）的手术效果。本研究旨在比较RPN和OPN的围手术期及肿瘤学结局。
回顾性收集了2006年至2014年在六个泌尿外科学术科室接受部分肾切除术的所有患者的数据。比较了OPN组和RPN组患者的围手术期结局。采用Kaplan-Meier法估计癌症特异性生存率（CSS）和无复发生存率（RFS），并使用对数秩检验进行比较。
该研究纳入了1800例患者：937例行RPN，863例行OPN。机器人手术组患者的肿瘤较小（33.1对39.9mm；p<0.001），但RENAL评分相当（6.8对6.7；p=0.37）。OPN组的并发症发生率更高（28.6%对18%；p<0.001）。OPN患者的估计失血量更大（359.5对275ml；p<0.001），出血性并发症更常见（12.1%对6.9%；p<0.001）。机器人手术方法与更短的热缺血时间（WIT 15.7对18.6分钟；p<0.001）和更短的住院时间（4.7对10.1天；p<0.001）相关。在倾向评分加权分析中，OPN与RPN术后并发症风险的治疗加权调整比值比为2.11（95%置信区间，1.53-2.91；p<0.001）。OPN术后中位随访期为13个月，RPN为39个月（p<0.001），两组的CSS和RFS相似。在多变量分析中，RPN对并发症的发生有影响，但对WIT或RFS无影响。
在本研究中，RPN的手术创伤比OPN小，并发症更少，失血量更少，住院时间更短。两组的中期肿瘤学结局相似。
