Department of Urology, CHU Rangueil, 31000, Toulouse, France.
Department of Urology, CHU, Rennes, France.
World J Urol. 2018 Jun;36(6):897-904. doi: 10.1007/s00345-018-2208-8. Epub 2018 Feb 9.
This study aimed at reporting the long-term oncological outcomes of robotic partial nephrectomy (RPN) for renal cell carcinoma (RCC).
Data from all consecutive patients who underwent RAPN for RCC from July 2009 to January 2012 in three departments of urology were prospectively collected. Overall survival (OS), cancer-specific survival (CSS) and disease free-survival (DFS) were estimated using the Kaplan-Meier method. Prognostic factors associated with CSS were sought in univariate analysis. The log-rank test was used for categorical variables and the Cox model for continuous variables.
110 patients were included with a median follow-up of 64.4 months [95% CI = (61.0-66.7)]. Median age was 61 years (29-83) with 62.7% of men and 37.3% of women. Median RENAL score was 6 (4-10) with elective indications accounting for 95% of cases. Out of 27 patients (24.5%) who experienced peri-operative complication, 12 patients (10.9%) had a major complication (Clavien-Dindo grade ≥ 3). The TRIFECTA achievement rate was 52.7%. Three patients (2.7%) experienced local recurrence and seven patients (6.4%) progressed to a metastatic disease. 5-year OS, CSS, DFS were 94.9, 96.8, 86.4%, respectively. In univariate analysis, no pre/peri-operative characteristic was associated with DFS. No port-site metastasis was observed and there was one case of peritoneal carcinomatosis.
In this multicenter series, long-term OS, DFS and CSS after RPN appeared comparable to large series of open partial nephrectomy, with no port-site metastasis and one case of peritoneal carcinomatosis.
本研究旨在报告机器人辅助部分肾切除术（RAPN）治疗肾细胞癌（RCC）的长期肿瘤学结果。
前瞻性收集了 2009 年 7 月至 2012 年 1 月三个泌尿科部门连续接受 RAPN 治疗 RCC 的所有患者的数据。使用 Kaplan-Meier 方法估计总生存期（OS）、癌症特异性生存期（CSS）和无病生存期（DFS）。在单因素分析中寻找与 CSS 相关的预后因素。对数秩检验用于分类变量，Cox 模型用于连续变量。
共纳入 110 例患者，中位随访时间为 64.4 个月[95%置信区间（61.0-66.7）]。中位年龄为 61 岁（29-83 岁），男性占 62.7%，女性占 37.3%。中位 RENAL 评分 6 分（4-10 分），95%的病例为选择性适应证。27 例（24.5%）患者发生围手术期并发症，其中 12 例（10.9%）发生严重并发症（Clavien-Dindo 分级≥3 级）。TRIFECTA 达成率为 52.7%。3 例（2.7%）患者发生局部复发，7 例（6.4%）患者进展为转移性疾病。5 年 OS、CSS、DFS 分别为 94.9%、96.8%、86.4%。单因素分析显示，DFS 与术前/围手术期特征无关。未观察到端口部位转移，且有 1 例腹膜癌病。
在这项多中心研究中，RAPN 后的长期 OS、DFS 和 CSS 与大型开放部分肾切除术系列结果相当，无端口部位转移，且有 1 例腹膜癌病。
