Reynolds Christopher R, Delto Joan C, Paulucci David J, Weinstein Corey, Badani Ketan, Eun Daniel, Abaza Ronney, Porter James, Bhandari Akshay, Hemal Ashok K
Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Division of Urology, Columbia University at Mount Sinai, Miami Beach, FL, USA.
BJU Int. 2017 Dec;120(6):842-847. doi: 10.1111/bju.13960. Epub 2017 Aug 11.
To compare perioperative and functional outcomes of patients with cT1a or cT1b renal masses undergoing robotic partial nephrectomy (RPN) in a large multi-institutional study PATIENTS AND METHODS: The present retrospective Institutional Review Board-approved multi-institutional study utilised a prospectively maintained database to identify patients undergoing RPN by six surgeons for a solitary cT1a (n = 1 307) or cT1b (n = 377) renal mass from 2006 to 2016. Perioperative and renal function outcomes at discharge and at a median follow-up of 12.2 months were compared in univariable and multivariable regression analyses adjusting for surgeon performing the procedure and date of surgery.
In univariable analysis, cT1b masses were associated with longer operative time (190.0 vs 159.0 min, P < 0.001), longer warm ischaemia time (18.8 vs 15.0 min, P < 0.001), higher estimated blood loss (150.0 vs 100.0 mL, P < 0.001), more intraoperative complications (5.6% vs 2.4%, P = 0.034), and more surgical postoperative complications (10.1% vs 5.7%, P =0.002). Results were similar in multivariable analysis with additional findings including more overall postoperative complications (odds ratio 1.55, P = 0.015) and longer length of stay (P < 0.001) associated with cT1b masses. There were no differences in the risk of progression of chronic kidney disease stage at 12.2 months, positive surgical margins, or major postoperative complications.
Although our study shows a longer operative time, longer warm ischemia time, and higher complication rate for patients undergoing RPN for cT1b renal masses, the magnitude of these differences is small. RPN should be considered for cT1b lesions when anatomical and spatial location allow for a feasible procedure.
在一项大型多机构研究中，比较接受机器人辅助部分肾切除术（RPN）的cT1a或cT1b期肾肿块患者的围手术期和功能结局。
本回顾性研究经机构审查委员会批准，是一项多机构研究，利用一个前瞻性维护的数据库，确定2006年至2016年期间由6位外科医生为孤立性cT1a期（n = 1307）或cT1b期（n = 377）肾肿块实施RPN的患者。在单变量和多变量回归分析中，比较了出院时以及中位随访12.2个月时的围手术期和肾功能结局，并对实施手术的外科医生和手术日期进行了校正。
在单变量分析中，cT1b期肿块与更长的手术时间（190.0对159.0分钟，P < 0.001）、更长的热缺血时间（18.8对15.0分钟，P < 0.001）、更高的估计失血量（150.0对100.0毫升，P < 0.001）、更多的术中并发症（5.6%对2.4%，P = 0.034）以及更多的术后手术并发症（10.1%对5.7%，P = 0.002）相关。多变量分析结果相似，其他发现包括与cT1b期肿块相关的更多总体术后并发症（比值比1.55，P = 0.015）和更长的住院时间（P < 0.001）。在12.2个月时慢性肾病分期进展风险、手术切缘阳性或主要术后并发症方面无差异。
尽管我们的研究表明，接受cT1b期肾肿块RPN的患者手术时间更长、热缺血时间更长且并发症发生率更高，但这些差异的程度较小。当解剖和空间位置允许可行的手术时，cT1b期病变应考虑行RPN。
