Arora Sohrab, Abaza Ronney, Adshead James M, Ahlawat Rajesh K, Challacombe Benjamin J, Dasgupta Prokar, Gandaglia Giorgio, Moon Daniel A, Yuvaraja Thyavihally B, Capitanio Umberto, Larcher Alessandro, Porpiglia Francesco, Porter James R, Mottrie Alexander, Bhandari Mahendra, Rogers Craig
Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
Department of Urology, Ohio Health Dublin Methodist Hospital, Dublin, OH, USA.
BJU Int. 2018 Jan;121(1):119-123. doi: 10.1111/bju.13967. Epub 2017 Aug 16.
To analyse the outcomes of robot-assisted partial nephrectomy (RAPN) in patients with a solitary kidney in a large multi-institutional database.
In all, 2755 patients in the Vattikuti Collective Quality Initiative database underwent RAPN by 22 surgeons at 14 centres in nine countries. Of these patients, 74 underwent RAPN with a solitary kidney between 2007 and 2016. We retrospectively analysed the functional and oncological outcomes of these 74 patients. A 'trifecta' of outcomes was assessed, with trifecta defined as a warm ischaemia time (WIT) of <20 min, negative surgical margins, and no complications intraoperatively or within 3 months of RAPN.
All 74 patients underwent RAPN successfully with one conversion to radical nephrectomy. The median (interquartile range [IQR]) operative time was 180 (142-230) min. Early unclamping was used in 11 (14.9%) patients and zero ischaemia was used in 12 (16.2%). Trifecta outcomes were achieved in 38 of 66 patients (57.6%). The median (IQR) WIT was 15.5 (8.75-20.0) min for the entire cohort. The overall complication rate was 24.1% and the rate of Clavien-Dindo grade ≤II complications was 16.3%. Positive surgical margins were present in four cases (5.4%). The median (IQR) follow-up was 10.5 (2.12-24.0) months. The median drop in estimated glomerular filtration rate at 3 months was 7.0 mL/min/1.72 m (11.01%).
Our findings suggest that RAPN is a safe and effective treatment option for select renal tumours in solitary kidneys in terms of a trifecta of negative surgical margins, WIT of <20 min, and low operative and perioperative morbidity.
在一个大型多机构数据库中分析机器人辅助部分肾切除术（RAPN）治疗孤立肾患者的疗效。
Vattikuti集体质量改进数据库中的2755例患者在9个国家14个中心由22名外科医生进行了RAPN。其中，74例患者在2007年至2016年间因孤立肾接受了RAPN。我们回顾性分析了这74例患者的功能和肿瘤学结局。评估了“三连胜”结局，三连胜定义为热缺血时间（WIT）<20分钟、手术切缘阴性且RAPN术中或术后3个月内无并发症。
所有74例患者均成功接受了RAPN，1例转为根治性肾切除术。中位（四分位间距[IQR]）手术时间为180（142 - 230）分钟。11例（14.9%）患者采用早期松开阻断，12例（16.2%）患者采用零缺血。66例患者中有38例（57.6%）实现了三连胜结局。整个队列的中位（IQR）WIT为分钟。总体并发症发生率为24.1%，Clavien-Dindo分级≤II级并发症发生率为16.3%。4例（5.4%）出现手术切缘阳性。中位（IQR）随访时间为10.5（2.12 - 24.0）个月。3个月时估计肾小球滤过率的中位下降值为7.0 mL/min/1.72 m（11.01%）。
我们的研究结果表明，就手术切缘阴性、WIT<20分钟以及低手术和围手术期发病率的三连胜而言，RAPN是治疗孤立肾中特定肾肿瘤的一种安全有效的治疗选择。
