Alimi Quentin, Peyronnet Benoit, Sebe Philippe, Cote Jean-François, Kammerer-Jacquet Solene-Florence, Khene Zine-Eddine, Pradere Benjamin, Mathieu Romain, Verhoest Gregory, Guillonneau Bertrand, Bensalah Karim
1 Department of Urology, CHU Rennes , Rennes, France .
2 Department of Urology, Diaconesses-Croix St Simon Hospital , Paris, France .
J Laparoendosc Adv Surg Tech A. 2018 Sep;28(9):1047-1052. doi: 10.1089/lap.2017.0724. Epub 2018 Apr 17.
To compare the short-term outcomes of robot-assisted partial nephrectomy (RPN) and laparoscopic partial nephrectomy (LPN) when performed by highly experienced surgeons.
A prospective multicenter study was conducted, including the 50 last patients having undergone LPN and RPN for T1-T2 renal tumors in two institutions between 2013 and 2016, performed by two different surgeons with an experience of over 200 procedures each in LPN and RPN, respectively, at the beginning of the study. Perioperative parameters and functional and oncological outcomes were collected and compared between the LPN and RPN groups.
The laparoscopic approach was associated with a longer warm ischemia time (15.7 versus 23 minutes; P < .001) and hospital stay (3.6 versus 4.6 days; P = .01). Conversely, estimated blood loss was significantly higher in the RPN group (381 mL versus 215 mL; P < .001), but transfusion rates were similar between the two groups (8% versus 6%; P = .33). In the RPN group, three patients (6%) required conversion to open partial nephrectomy and three patients (6%) required a conversion to radical nephrectomy (RN), while no conversion was needed in the LPN group. There were no differences in terms of perioperative complications, and change in renal function was comparable in the two groups postoperatively. Positive surgical margin rates were similar in the RPN and LPN groups (2% versus 6%; P = .36). After a median follow-up of 19 and 14 months in the RPN and LPN groups, respectively (P = .38), recurrence-free survivals did not differ significantly (P = .94).
In this series, perioperative and short-term oncological and functional outcomes appeared broadly comparable between RPN and LPN when performed by highly experienced surgeons.
比较由经验丰富的外科医生实施的机器人辅助部分肾切除术（RPN）和腹腔镜部分肾切除术（LPN）的短期疗效。
开展一项前瞻性多中心研究，纳入2013年至2016年间在两家机构接受LPN和RPN治疗T1 - T2期肾肿瘤的最后50例患者，研究开始时由两位不同的外科医生进行手术，他们分别在LPN和RPN方面均有超过200例手术经验。收集LPN组和RPN组的围手术期参数以及功能和肿瘤学结局并进行比较。
腹腔镜手术方式与更长的热缺血时间（15.7分钟对23分钟；P <.001）和住院时间（3.6天对4.6天；P =.01）相关。相反，RPN组的估计失血量显著更高（381 mL对215 mL；P <.001），但两组的输血率相似（8%对6%；P =.33）。在RPN组中，3例患者（6%）需要转为开放性部分肾切除术，3例患者（6%）需要转为根治性肾切除术（RN），而LPN组无需转换。围手术期并发症方面无差异，两组术后肾功能变化相当。RPN组和LPN组的手术切缘阳性率相似（2%对6%；P =.36）。RPN组和LPN组分别进行中位随访19个月和14个月后（P =.38），无复发生存率无显著差异（P =.94）。
在本系列研究中，由经验丰富的外科医生实施时，RPN和LPN的围手术期以及短期肿瘤学和功能结局大致相当。
