Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China; Department of Urology, First Affiliated Hospital of Nanchang University (LC), Nanchang, China.
Department of Urology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China; Department of Urology, First Affiliated Hospital of Nanchang University (LC), Nanchang, China.
J Urol. 2017 Dec;198(6):1241-1246. doi: 10.1016/j.juro.2017.06.094. Epub 2017 Jul 8.
We compared treatment outcomes of robotic vs open inferior vena cava thrombectomy for renal tumors with level I-II inferior vena cava tumor thrombus.
We retrospectively reviewed the medical records of patients who underwent robotic or open inferior vena cava thrombectomy between 2006 and 2016. To reduce the inherent biases of a nonrandomized study the robotic and open groups were matched 1:1 based on key variables. Perioperative data and oncologic outcomes were reviewed. Progression-free and overall survival was analyzed using Kaplan-Meier survival curves and compared between groups using the log rank test.
A total of 31 and 37 patients underwent robotic and open inferior vena cava thrombectomy, respectively. After matching there were no significant differences in baseline characteristics between the groups. Of the matched cohorts the robotic cohort had significantly shorter median operative time (150 vs 230 minutes, p <0.001), lower median estimated blood loss (250 vs 1,000 ml, p <0.001), a lower rate of blood transfusion (6.5% vs 54.8%, p <0.001), a lower median transfusion requirement (420 vs 790 ml, p = 0.012) and a shorter median postoperative hospital stay (5 vs 9 days, p <0.001). The postoperative complication rate was lower in the robotic group than in the open group (9.7% vs 29.0%, p = 0.070). However, there were no significant differences in oncologic outcomes between the groups.
Robotic inferior vena cava thrombectomy can achieve more favorable perioperative results and similar oncologic outcomes compared with open inferior vena cava thrombectomy. Prospective studies with a larger sample size and longer followup are needed to validate our findings.
我们比较了机器人与开放肾静脉下腔静脉血栓切除术治疗 I-II 级下腔静脉肿瘤血栓的治疗效果。
我们回顾性分析了 2006 年至 2016 年间接受机器人或开放下腔静脉血栓切除术的患者的病历。为了减少非随机研究的固有偏差，我们根据关键变量将机器人组和开放组进行了 1:1 匹配。回顾了围手术期数据和肿瘤学结果。使用 Kaplan-Meier 生存曲线分析无进展和总生存率，并使用对数秩检验比较组间差异。
共有 31 例和 37 例患者分别接受了机器人和开放下腔静脉血栓切除术。匹配后，两组间基线特征无显著差异。在匹配队列中，机器人组的中位手术时间明显更短（150 分钟 vs 230 分钟，p <0.001），中位估计出血量更少（250 毫升 vs 1000 毫升，p <0.001），输血率更低（6.5% vs 54.8%，p <0.001），中位输血需求更少（420 毫升 vs 790 毫升，p = 0.012），术后住院时间更短（5 天 vs 9 天，p <0.001）。机器人组术后并发症发生率低于开放组（9.7% vs 29.0%，p = 0.070）。然而，两组的肿瘤学结果无显著差异。
与开放下腔静脉血栓切除术相比，机器人下腔静脉血栓切除术可获得更有利的围手术期结果和相似的肿瘤学结果。需要更大样本量和更长随访时间的前瞻性研究来验证我们的发现。
