Lebentrau Steffen, Rauter Sven, Baumunk Daniel, Christoph Frank, König Frank, May Matthias, Schostak Martin
Department of Urology and Pediatric Urology, Ruppin Clinics, Brandenburg Medical Center and School of Medicine, Fehrbelliner Straße 38, 16816, Neuruppin, Germany.
Department of Urology and Pediatric Urology, Magdeburg University Medical Center, Leipziger Str. 44, 39120, Magdeburg, Germany.
World J Urol. 2017 May;35(5):753-759. doi: 10.1007/s00345-016-1905-4. Epub 2016 Aug 12.
If technically feasible, organ-preservation is indicated for T1 renal cell carcinoma (RCC), since partial nephrectomy (PN) is equivalent to radical nephrectomy with regard to tumor-specific survival and probably achieves better overall survival. Treatment results of a training clinic were assessed with regard to guideline adherence and treatment quality.
Based on 220 open interventions in the time periods 2006-2009 (TP1) and 2010-2013 (TP2), a retrospective single center examination was performed to determine the influence of patient-age, sex, BMI, ASA-score, preoperative eGFR, PADUA-score and surgeon's experience on PN-rate and trifecta-outcome (R0 resection, warm ischemia time ≤25 min, no intraoperative complications and no blood-transfusion and postoperative complications grade ≤1 Clavien and Dindo).
PN-rate increased from 36.1 % in TP1 to 72.4 % in TP2. Despite significantly higher PADUA-scores in TP2 than in TP1 (p = 0.0038), the trifecta-rate did not differ significantly (TP1 65.7 %; TP2 70.8 %; p = 0.666). Only the PADUA-score exerted an independent influence on the endpoints "organ-preservation" and "trifecta-outcome".
This study again demonstrated that the PADUA-score is a robust predictor of technical feasibility and treatment outcome for open PN. Consistent implementation of guidelines for nephron sparing surgery in RCC ≤7 cm is possible even in the setting of a training clinic and need not be associated with compromised treatment quality despite the increasing level of difficulty. Depending on the author, there are various definitions of trifecta-outcome. A uniform trifecta-concept would be desirable.
如果技术上可行，对于T1期肾细胞癌（RCC）应采用器官保留治疗，因为在肿瘤特异性生存率方面，部分肾切除术（PN）与根治性肾切除术相当，并且可能获得更好的总生存率。评估了一家培训诊所的治疗结果，以了解其对指南依从性和治疗质量的情况。
基于2006 - 2009年（TP1）和2010 - 2013年（TP2）期间的220例开放手术，进行了一项回顾性单中心研究，以确定患者年龄、性别、体重指数（BMI）、美国麻醉医师协会（ASA）评分、术前估算肾小球滤过率（eGFR）、PADUA评分和外科医生经验对PN率和三连胜结果（R0切除、热缺血时间≤25分钟、无术中并发症、无输血且术后并发症Clavien - Dindo分级≤1级）的影响。
PN率从TP1期的36.1%升至TP2期的72.4%。尽管TP2期的PADUA评分显著高于TP1期（p = 0.0038），但三连胜率无显著差异（TP1期为65.7%；TP2期为70.8%；p = 0.666）。只有PADUA评分对“器官保留”和“三连胜结果”这两个终点有独立影响。
本研究再次表明，PADUA评分是开放PN技术可行性和治疗结果的可靠预测指标。即使在培训诊所的环境中，对于≤7cm的RCC，一致实施保留肾单位手术指南也是可行的，尽管难度不断增加，但不一定会导致治疗质量下降。根据作者不同，三连胜结果有各种定义。理想的是有一个统一的三连胜概念。
