Division of Urology, European Institute of Oncology, Milan, Italy; Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania.
Division of Urology, European Institute of Oncology, Milan, Italy; Department of Urology, University of Medicine and Pharmacy 'Iuliu Hatieganu', Cluj-Napoca, Romania.
Eur Urol Focus. 2019 Jul;5(4):636-641. doi: 10.1016/j.euf.2017.10.005. Epub 2017 Oct 27.
Nowadays, there is a debate about which surgical treatment should be best for clinical T1 renal tumors. If the oncological outcomes are considered, there are many open and laparoscopic series published. As far as robotic series are concerned, only a few of them report 5-yr oncological outcomes.
The aim of this study was to analyze robot-assisted partial nephrectomy (RAPN) midterm oncological outcomes achieved in a tertiary robotic reference center.
DESIGN, SETTING, AND PARTICIPANTS: Between April 2009 and September 2013, 123 consecutive patients with clinical T1-stage renal masses underwent RAPN in our tertiary cancer center. Inclusion criteria were as follows: pathologically confirmed renal cell carcinomas (RCCs) and follow-up for >12 mo. Eighteen patients were excluded due to follow-up of <12 mo and 15 due to benign final pathology. Median follow-up was 59 mo (interquartile range 44-73 mo). Patients were followed according to guideline recommendations and institutional protocol.
Outcomes were measured by time to disease progression, overall survival, or time to cancer-specific death. Kaplan-Meier method was used to estimate survival; log-rank tests were applied for pair-wise comparison of survival.
From the 90 patients included, 66 (73.3%) had T1a, 12 (13.3%) T1b, three (3.3%) T2a, and nine (10%) T3a tumors. Predominant histological type was clear cell carcinoma: 67 (74.5%). Fuhrmann grade 1 and 2 was found in 73.3% of all malignant tumors. Two patients (2.2%) had positive surgical margins, and complication rate was 17.8%. Relapse rate was 7.7%, including two cases (2.2%) of local recurrences and five (5.5%) distant metastasis. Five-year disease-free survival was 90.9%, 5-yr cancer-specific survival was 97.5%, and 5-yr overall survival was 95.1%.
Midterm oncological outcomes after RAPN for localized RCCs (predominantly T1a tumors of low anatomic complexity) were shown to be good, adding significant evidence to support the oncological efficacy and safety of RAPN for the treatment of this type of tumors.
Robot-assisted partial nephrectomy seems to be the most promising minimally invasive approach in the treatment of renal masses suitable for organ-sparing surgery as midterm (5 yr) oncological outcomes are excellent.
目前，对于临床 T1 期肾肿瘤，哪种手术治疗方法最佳仍存在争议。如果考虑肿瘤学结果，有许多开放和腹腔镜系列研究已发表。至于机器人系列研究，只有少数研究报告了 5 年的肿瘤学结果。
本研究旨在分析在三级机器人参考中心进行的机器人辅助部分肾切除术（RAPN）的中期肿瘤学结果。
设计、设置和参与者：2009 年 4 月至 2013 年 9 月，在我们的三级癌症中心，123 例连续临床 T1 期肾肿块患者接受了 RAPN。纳入标准如下：病理证实为肾细胞癌（RCC）和随访时间>12 个月。由于随访时间<12 个月，18 例患者被排除在外，由于最终病理为良性，15 例患者被排除在外。中位随访时间为 59 个月（四分位距 44-73 个月）。根据指南建议和机构方案对患者进行随访。
通过疾病进展、总生存或癌症特异性死亡时间来衡量结果。Kaplan-Meier 法用于估计生存情况；对数秩检验用于生存的两两比较。
在纳入的 90 例患者中，66 例（73.3%）为 T1a，12 例（13.3%）为 T1b，3 例（3.3%）为 T2a，9 例（10%）为 T3a 肿瘤。主要组织学类型为透明细胞癌：67 例（74.5%）。所有恶性肿瘤中 Fuhrmann 分级 1 和 2 的比例为 73.3%。2 例（2.2%）患者有阳性手术切缘，并发症发生率为 17.8%。复发率为 7.7%，包括 2 例（2.2%）局部复发和 5 例（5.5%）远处转移。5 年无病生存率为 90.9%，5 年癌症特异性生存率为 97.5%，5 年总生存率为 95.1%。
RAPN 治疗局限性 RCC（主要为解剖复杂性低的 T1a 肿瘤）的中期肿瘤学结果良好，为 RAPN 治疗此类肿瘤的肿瘤学疗效和安全性提供了重要证据。
机器人辅助部分肾切除术似乎是治疗适合保留器官手术的肾肿块最有希望的微创方法，因为中期（5 年）的肿瘤学结果非常出色。
