Department of Urology, UC San Diego Health System, Moores UCSD Cancer Center, 3855 Health Sciences Drive, La Jolla, CA, 93093-0987, USA.
Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
World J Urol. 2018 Aug;36(8):1255-1262. doi: 10.1007/s00345-018-2261-3. Epub 2018 Mar 12.
We compared renal functional outcomes of robotic (RPN) and open partial nephrectomy (OPN) in patients with chronic kidney disease (CKD), a definite indication for nephron-sparing surgery.
A multicenter retrospective analysis of OPN and RPN in patients with baseline ≥ CKD Stage III [estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m] was performed. Primary outcome was change in eGFR (ΔeGFR, mL/min/1.73 m) between preoperative and last follow-up with respect to RENAL nephrometry score group [simple (4-6), intermediate (7-9), complex (10-12)]. Secondary outcomes included eGFR decline > 50%.
728 patients (426 OPN, 302 RPN, mean follow-up 33.3 months) were analyzed. Similar RENAL score distribution (p = 0.148) was noted between groups. RPN had lower median estimated blood loss (p < 0.001), and hospital stay (3 vs. 5 days, p < 0.001). Median ischemia time (OPN 23.7 vs. RPN 21.5 min, p = 0.089), positive margin (p = 0.256), transfusion (p = 0.166), and 30-day complications (p = 0.208) were similar. For OPN vs. RPN, mean ΔeGFR demonstrated no significant difference for simple (0.5 vs. 0.3, p = 0.328), intermediate (2.1 vs. 2.1, p = 0.384), and complex (4.9 vs. 6.1, p = 0.108). Cox regression analysis demonstrated that decreasing preoperative eGFR (OR 1.10, p = 0.001) and complex RENAL score (OR 5.61, p = 0.03) were independent predictors for eGFR decline > 50%. Kaplan-Meier analysis demonstrated 5-year freedom from eGFR decline > 50% of 88.6% for OPN and 88.3% for RPN (p = 0.724).
RPN and OPN demonstrated similar renal functional outcomes when stratified by tumor complexity group. Increasing tumor age and tumor complexity were primary drivers associated with functional decline. RPN provides similar renal functional outcomes to OPN in appropriately selected patients.
我们比较了机器人辅助肾部分切除术（RPN）和开放性肾部分切除术（OPN）在慢性肾脏病（CKD）患者中的肾功能结果，CKD 是保肾手术的明确适应证。
对基线 CKD Ⅲ期[估算肾小球滤过率（eGFR）<60 mL/min/1.73 m 2 ]的 OPN 和 RPN 患者进行了多中心回顾性分析。主要结局是根据 RENAL 肾肿瘤评分[简单（4-6 分）、中度（7-9 分）、复杂（10-12 分）]比较术前和末次随访时 eGFR 的变化（ΔeGFR，mL/min/1.73 m 2 ）。次要结局包括 eGFR 下降>50%。
共分析了 728 例患者（426 例行 OPN，302 例行 RPN，平均随访 33.3 个月）。两组的 RENAL 评分分布相似（p=0.148）。RPN 的中位估计失血量（p<0.001）和住院时间（3 天比 5 天，p<0.001）较低。中位缺血时间（OPN 23.7 分钟比 RPN 21.5 分钟，p=0.089）、阳性切缘（p=0.256）、输血（p=0.166）和 30 天并发症（p=0.208）相似。对于 OPN 与 RPN，简单（0.5 比 0.3，p=0.328）、中度（2.1 比 2.1，p=0.384）和复杂（4.9 比 6.1，p=0.108）肿瘤的平均ΔeGFR 无显著差异。Cox 回归分析表明，术前 eGFR 降低（OR 1.10，p=0.001）和复杂 RENAL 评分（OR 5.61，p=0.03）是 eGFR 下降>50%的独立预测因素。Kaplan-Meier 分析显示，OPN 和 RPN 的 5 年 eGFR 下降>50%的无事件率分别为 88.6%和 88.3%（p=0.724）。
在肿瘤复杂性分组的情况下，RPN 和 OPN 的肾功能结果相似。肿瘤年龄和肿瘤复杂性的增加是与功能下降相关的主要驱动因素。在适当选择的患者中，RPN 可为患者提供与 OPN 相似的肾功能结果。
