Hassan Abd-El R, Raheem Omer A, Berquist Sean, Beksac Alp T, Bloch Aaron, Field Charles, Lee Hak J, Mehrazin Reza, Holden Marc, McDonald Michelle, Hamilton Zachary, Liss Michael, Derweesh Ithaar H
Department of Urology, UC San Diego Health System, La Jolla, CA, USA.
Department of Urology, and University of Tennessee Health Science Center, Memphis, TN, USA.
Minerva Urol Nefrol. 2017 Dec;69(6):596-603. doi: 10.23736/S0393-2249.17.02785-0. Epub 2017 Mar 10.
The aim of this study was to compare outcomes of laparoendoscopic single-site surgery (LESS) and multiport laparoscopic (MPL) radical nephrectomy (RN) for clinical T1b/T2a renal masses, as concerns continue regarding suitability and benefit of LESS for larger renal masses.
Retrospective single-surgeon comparison of LESS- and MPL-RN between 7/2005 and 11/2014. Sixty-three patients underwent LESS-RN (44 cT1b/19 cT2a); 133 underwent MPL (83 cT1b/50 cT2a). All patients were managed with a standardized care pathway. Primary outcome was length of hospital stay (LOS). Secondary outcomes included operative time, estimated blood loss (EBL), complications, discharge pain score (visual analog pain, VAP), narcotic requirement (morphine equivalents, MSO4eq).
130/133 MPL and 62/63 LESS were successfully performed. For MPL and LESS groups: mean tumor diameter (cm) for cT1b was 5.3 vs. 5.4 (P=0.689); and for cT2a was 8.2 vs. 8.3 (P=0.728); mean OR time (min) was 126.3 vs. 132.7 (P=0.314); mean EBL (mL) was 139.5 vs.127.8 (P=0.49). No significant differences in complications were noted (P=0.781). LESS was associated with significant reductions in LOS (2.14 vs. 2.45 days, P=0.043), discharge VAP (1.3 vs. 2.2, P<0.001), and narcotic use (5.9 vs. 10.7 MSO4eq, P<0.001).
LESS is comparable to MPL-RN for cT1b and T2a renal tumors in terms of perioperative parameters and may confer benefit with respect to LOS and analgesic requirement.
本研究旨在比较腹腔镜单孔手术（LESS）与多孔腹腔镜（MPL）根治性肾切除术（RN）治疗临床T1b/T2a期肾肿块的疗效，因为对于较大肾肿块，LESS的适用性和益处仍存在争议。
对2005年7月至2014年11月间由同一外科医生实施的LESS-RN和MPL-RN进行回顾性比较。63例患者接受LESS-RN（44例cT1b/19例cT2a）；133例接受MPL（83例cT1b/50例cT2a）。所有患者均采用标准化护理路径。主要结局指标为住院时间（LOS）。次要结局指标包括手术时间、估计失血量（EBL）、并发症、出院时疼痛评分（视觉模拟疼痛评分，VAP）、麻醉药物需求量（吗啡当量，MSO4eq）。
133例MPL患者中有130例、63例LESS患者中有62例手术成功完成。MPL组和LESS组：cT1b患者的平均肿瘤直径（cm）分别为5.3和5.4（P = 0.689）；cT2a患者分别为8.2和8.3（P = 0.728）；平均手术时间（分钟）分别为126.3和132.7（P = 0.314）；平均EBL（mL）分别为139.5和127.8（P = 0.49）。并发症方面未发现显著差异（P = 0.781）。LESS组的LOS显著缩短（2.14天对2.45天，P = 0.043），出院时VAP降低（1.3对2.2，P < 0.001），麻醉药物使用量减少（5.9对10.7 MSO4eq，P < 0.001）。
对于cT1b和T2a期肾肿瘤，LESS在围手术期参数方面与MPL-RN相当，并且在LOS和镇痛药物需求方面可能具有优势。
