Department of Urology, Urological Science Institute, Yonsei Wonju University College of Medicine, Wonju, Korea.
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
BJU Int. 2018 Oct;122(4):618-626. doi: 10.1111/bju.14250. Epub 2018 May 24.
To compare outcomes at a 5-year median follow-up among different partial nephrectomy (PN) approaches: robot-assisted (RAPN), laparoscopic (LPN) and open partial nephrectomy (OPN).
We retrospectively analysed 1 308 patients who underwent PN (RAPN, n = 380; LPN, n = 206; OPN, n = 722) between 2006 and 2012 at one of four academic centres. We performed 1:1:1 propensity-score-matching adjustment based on confounding variables among groups, and 366 patients (122 in each group) were included in the final analysis. Survival rates were analysed using the Kaplan-Meier method.
The median follow-up periods were 60, 59.8 and 64.1 months for RAPN, LPN and OPN, respectively. In the matched groups, RAPN resulted in significantly lower mean estimated blood loss compared with LPN (P = 0.025) and OPN (P = 0.040), while LPN was associated with a longer mean operating time compared with RAPN (P = 0.001) and OPN (P = 0.001). The hospital stay was shorter in the RAPN group (P = 0.008). Regarding the oncological outcomes, there were no significant differences among the three groups in local recurrence rate (P = 0.882), distant metastasis rate (P = 0.816) or deaths from cancer (P = 0.779). At latest follow-up, the incidence of chronic kidney disease (CKD) upstaging was significantly lower in RAPN compared with LPN (20.55% vs 32%; P = 0.035) and OPN (20.5% vs 33.6%; P = 0.038). The 5-year CKD free-survival rate was significantly higher (78.4%) in the RAPN group compared with 58.8% and 65.8% in the LPN and OPN groups, respectively (log-rank P = 0.031).
In the present study, RAPN, LPN and OPN had similar local recurrence, distant metastasis and cancer-related death rates at a 5-year median follow-up. In terms of functional outcomes, RAPN was associated with a lower incidence of CKD upstaging compared with OPN and LPN.
比较不同部分肾切除术（PN）方法（机器人辅助肾部分切除术 [RAPN]、腹腔镜肾部分切除术 [LPN]和开放肾部分切除术 [OPN]）在 5 年中位随访期间的结果。
我们回顾性分析了 2006 年至 2012 年在四个学术中心中的一个中心接受 PN（RAPN，n=380；LPN，n=206；OPN，n=722）的 1308 名患者。我们根据组间混杂变量对各组进行了 1:1:1 倾向评分匹配调整，最终有 366 名患者（每组 122 名）纳入最终分析。使用 Kaplan-Meier 方法分析生存率。
RAPN、LPN 和 OPN 的中位随访时间分别为 60、59.8 和 64.1 个月。在匹配组中，RAPN 与 LPN（P=0.025）和 OPN（P=0.040）相比，平均估计失血量明显较低，而 LPN 与 RAPN（P=0.001）和 OPN（P=0.001）相比，手术时间明显较长。RAPN 组的住院时间较短（P=0.008）。关于肿瘤学结果，三组局部复发率（P=0.882）、远处转移率（P=0.816）或癌症死亡率（P=0.779）无显著差异。在最近的随访中，RAPN 组慢性肾脏病（CKD）升级的发生率明显低于 LPN（20.55%比 32%；P=0.035）和 OPN（20.5%比 33.6%；P=0.038）。RAPN 组 5 年 CKD 无进展生存率明显高于 LPN 组（78.4%比 58.8%和 65.8%），差异具有统计学意义（log-rank P=0.031）。
在本研究中，RAPN、LPN 和 OPN 在 5 年中位随访期间局部复发、远处转移和癌症相关死亡率相似。在功能结果方面，与 OPN 和 LPN 相比，RAPN 发生 CKD 升级的发生率较低。
