Laviana Aaron A, Tan Hung-Jui, Hu Jim C, Weizer Alon Z, Chang Sam S, Barocas Daniel A
Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Curr Opin Urol. 2018 Mar;28(2):108-114. doi: 10.1097/MOU.0000000000000483.
To perform a bicenter, retrospective study of perioperative outcomes of retroperitoneal versus transperitoneal robotic-assisted laparoscopic partial nephrectomy (RALPN) and assess costs using time-driven activity-based costing (TDABC). We identified 355 consecutive patients who underwent RALPN at University of California Los Angeles and the University of Michigan during 2009-2016. We matched according to RENAL nephrometry score, date, and institution for 78 retroperitoneal versus 78 transperitoneal RALPN. Unadjusted analyses were performed using McNemar's Chi-squared or paired t test, and adjusted analyses were performed using multivariable repeated measures regression analysis. From multivariable models, predicted probabilities were derived according to approach. Cost analysis was performed using TDABC.
Patients treated with retroperitoneal versus transperitoneal RALPN were similar in age (P = 0.490), sex (P = 0.715), BMI (P = 0.273), and comorbidity (P = 0.393). Most tumors were posterior or lateral in both the retroperitoneal (92.3%) and transperitoneal (85.9%) groups. Retroperitoneal RALPN was associated with shorter operative times (167.0 versus 191.1 min, P = 0.001) and length of stay (LOS) (1.8 versus 2.7 days, P < 0.001). There were no differences in renal function preservation or cancer control. In adjusted analyses, retroperitoneal RALPN was 17.6-min shorter (P < 0.001) and had a 76% lower probability of LOS at least 2 days (P < 0.001). Utilizing TDABC, transperitoneal RALPN added $2337 in cost when factoring in disposable equipment, operative time, LOS, and personnel.
In two high-volume, tertiary centers, retroperitoneal RALPN is associated with reduced operative times and shortened LOS in posterior and lateral tumors, whereas sharing similar clinicopathologic outcomes, which may translate into lower healthcare costs. Further investigation into anterior tumors is needed.
进行一项双中心回顾性研究，比较后腹腔镜与经腹腔机器人辅助腹腔镜肾部分切除术（RALPN）的围手术期结果，并使用时间驱动作业成本法（TDABC）评估成本。我们确定了2009年至2016年期间在加利福尼亚大学洛杉矶分校和密歇根大学连续接受RALPN的355例患者。我们根据RENAL肾计量评分、日期和机构，对78例后腹腔镜RALPN与78例经腹腔RALPN进行匹配。未调整分析采用McNemar卡方检验或配对t检验，调整分析采用多变量重复测量回归分析。从多变量模型中，根据手术方式得出预测概率。使用TDABC进行成本分析。
接受后腹腔镜与经腹腔RALPN治疗的患者在年龄（P = 0.490）、性别（P = 0.715）、体重指数（P = 0.273）和合并症（P = 0.393）方面相似。在后腹腔镜组（92.3%）和经腹腔组（85.9%）中，大多数肿瘤位于后侧或外侧。后腹腔镜RALPN与较短的手术时间（167.0分钟对191.1分钟，P = 0.001）和住院时间（LOS）（1.8天对2.7天，P < 0.001）相关。在肾功能保留或癌症控制方面无差异。在调整分析中，后腹腔镜RALPN的手术时间短17.6分钟（P < 0.001），LOS至少为2天的概率低76%（P < 0.001）。考虑到一次性设备、手术时间、LOS和人员，使用TDABC时，经腹腔RALPN的成本增加2337美元。
在两个高容量的三级中心，后腹腔镜RALPN与后侧和外侧肿瘤的手术时间缩短和LOS缩短相关，而临床病理结果相似，这可能转化为较低的医疗成本。需要对前侧肿瘤进行进一步研究。
