Matei Deliu Victor, Vartolomei Mihai Dorin, Musi Gennaro, Renne Giuseppe, Tringali Valeria Maria Lucia, Mistretta Francesco Alessandro, Delor Maurizio, Russo Andrea, Cioffi Antonio, Bianchi Roberto, Cozzi Gabriele, Di Trapani Ettore, Bottero Danilo, Cordima Giovanni, Lucarelli Giuseppe, Ferro Matteo, de Cobelli Ottavio
Division of Urology, European Institute of Oncology, Milan, Italy Department of Urology, University of Medicine and Pharmacy 'Iuliu Hatieganu' Cluj-Napoca Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Targu Mures, Romania Department of Laboratory and Pathology, European Institute of Oncology, Milan, Italy University of Milan, Milan Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy.
Medicine (Baltimore). 2017 May;96(18):e6771. doi: 10.1097/MD.0000000000006771.
The aim of this study was to assess the ability of pre-and intraoperative parameters, to predict the risk of perioperative complications after robot-assisted laparoscopic simple enucleation (RASE) of renal masses, and to evaluate the rate of trifecta achievement of this approach stratifying the cohort according to the use of ischemia during the enucleation.From April 2009 to June 2016, 129 patients underwent RASE at our Institution. We stratified the procedures in 2 groups: clamping and clamp-less RASE. After RASE, all specimens were retrospectively reviewed to assess the surface-intermediate-base (SIB) scoring system. Patients were followed-up according to the European Association of Urology guidelines recommendations. All pre-, intra-, and postoperative outcomes were prospectively collected in a customized database and retrospectively analyzed.A total of 112 (86.8%) patients underwent a pure RASE and 17 (13.2%) had a hybrid according to SIB classification system. The mean age was 61.17 years. In 21 patients (16.3%), complications occurred, 13 (61.9%) were Clavien 1 and 2, while 8 were Clavien 3a and b complications. Statistical significant association with complications was found in patients with American Society of Anestesiology (ASA) score 3 (44.5%, P = .04), longer mean operative time (OT) 195 versus 161.36 minutes (P =.03), mean postoperative hemoglobin (Hb) 10.1 versus 11.8 (P <.001), and mean ΔHb 3.59 versus 2.18 (P <.001). In multivariate logistic regression, only longer OT and ΔHb were statistical significant predictive factors for complications. In sub-group analysis, clamp-less RASE was safe in terms of complications (14.1%), positive surgical margins (1.3%), and mid-term local recurrence (1.3%). Although in this approach there is higher EBL (P = .01), this had no impact on ΔHb (P = .28). A clamp-less approach was associated with a higher rate of SIB 0 (71.8% vs 51%, P = .02), higher trifecta achievement (84.6% vs 62.7%, P = .004), and better impact on serum creatinine (mean 0.83 vs 0.91, P = .01).RASE of renal tumors is a safe technique with very good postoperative outcomes. Complication rate is low and associated with ASA score >3, longer OT, and ΔHb. RASE is suitable for the clamp-less approach, which allows to perform easier the pure enucleation (SIB 0) and to obtain higher rates of trifecta outcomes.
本研究的目的是评估术前和术中参数预测肾肿物机器人辅助腹腔镜单纯剜除术（RASE）后围手术期并发症风险的能力，并根据剜除术中是否使用缺血技术对队列进行分层，评估该方法的三联成功（trifecta）率。2009年4月至2016年6月，129例患者在我院接受了RASE。我们将手术分为两组：夹闭式和非夹闭式RASE。RASE术后，对所有标本进行回顾性评估，以评估表面-中间-基底（SIB）评分系统。根据欧洲泌尿外科学会指南建议对患者进行随访。所有术前、术中和术后结果均前瞻性收集到定制数据库中，并进行回顾性分析。根据SIB分类系统，共有112例（86.8%）患者接受了单纯RASE，17例（13.2%）为混合式。平均年龄为61.17岁。21例（16.3%）患者发生并发症，13例（61.9%）为Clavien 1和2级，8例为Clavien 3a和b级并发症。美国麻醉医师协会（ASA）评分3分的患者（44.5%，P = 0.04）、平均手术时间较长（OT）195分钟对161.36分钟（P = 0.03）、术后平均血红蛋白（Hb）10.1对11.8（P < 0.001）以及平均血红蛋白下降量（ΔHb）3.59对2.18（P < 0.001）与并发症有统计学显著相关性。在多因素逻辑回归分析中，只有较长的OT和ΔHb是并发症的统计学显著预测因素。在亚组分析中，非夹闭式RASE在并发症（14.1%）、手术切缘阳性（1.3%）和中期局部复发（1.3%）方面是安全的。尽管这种方法的术中出血量（EBL）较高（P = 0.01），但对ΔHb没有影响（P = 0.28）。非夹闭式方法与较高的SIB 0率（71.8%对51%，P = 0.02）、较高的三联成功（trifecta）率（84.6%对62.7%，P = 0.004）以及对血清肌酐的更好影响（平均0.83对0.91，P = 0.01）相关。肾肿瘤的RASE是一种安全的技术，术后效果非常好。并发症发生率低，与ASA评分>3、较长的OT和ΔHb相关。RASE适用于非夹闭式方法，该方法能更轻松地进行单纯剜除术（SIB 0）并获得更高的三联成功（trifecta）率。
