Department of Urology, Glickman Urological and Kidney Institute , Cleveland Clinic, Cleveland, Ohio.
J Endourol. 2018 Sep 12;32(9):831-836. doi: 10.1089/end.2018.0445.
To report a comparative analysis of outcomes in patients who underwent excisions of renal hilar tumors using both open and robotic approaches.
We retrospectively reviewed robotic and open patients who underwent partial nephrectomy of renal hilar tumors between 2011 and 2016. "Trifecta" was defined as negative surgical margins, no complications, and a glomerular filtration rate (GFR) preservation of ≥90% at last follow-up. Inverse probability of treatment weighting (IPTW) was applied to equilibrate treatment groups, minimize selection bias, and optimize inference on the basis of each patient's clinicodemographic characteristics.
One hundred robotic and 64 open patients had sufficient data for IPTW. After weighting, there were no statistical differences in baseline characteristics between the two groups (p < 0.05). On adjusted analyses, robotic partial nephrectomy (RPN) achieved equivalent rates of trifecta to open surgery (21.1% vs 13.9%, respectively, p = 0.387). There were no differences between robotic and open cohorts for negative margin rates (72.8% vs 90.4%, p = 0.124), absence of complications (68.6% vs 75.2%, p = 0.587), or GFR ≥90% (39.4% vs 21.6%, p = 0.111). The robotic cohort had a shorter mean length of stay (3.8 vs 5.0 days, p = 0.012), and no difference in estimated blood loss (253.3 vs 357.1, p = 0.091) or operating time (199.8 vs 200.4, p = 0.961).
In our analysis both open and RPN for hilar tumors were equally likely to achieve a low "trifecta" outcome with a shorter mean length of stay in the robotic cohort.
报告比较分析采用开放和机器人方法切除肾门肿瘤患者的结果。
我们回顾性分析了 2011 年至 2016 年间接受肾门肿瘤部分切除术的机器人和开放手术患者。“三联征”定义为切缘阴性、无并发症以及最后一次随访时肾小球滤过率（GFR）保留≥90%。应用逆概率治疗加权（IPTW）来平衡治疗组，最小化选择偏倚，并根据每位患者的临床和人口统计学特征优化推理。
100 例机器人组和 64 例开放组患者有足够的数据进行 IPTW。加权后，两组间基线特征无统计学差异（p＜0.05）。在调整分析中，机器人部分肾切除术（RPN）与开放手术的三联征率相当（分别为 21.1%和 13.9%，p=0.387）。机器人组和开放组的切缘阴性率（分别为 72.8%和 90.4%，p=0.124）、无并发症发生率（分别为 68.6%和 75.2%，p=0.587）或 GFR≥90%（分别为 39.4%和 21.6%，p=0.111）均无差异。机器人组的平均住院时间更短（3.8 天 vs 5.0 天，p=0.012），估计失血量（253.3 毫升 vs 357.1 毫升，p=0.091）或手术时间（199.8 分钟 vs 200.4 分钟，p=0.961）无差异。
在我们的分析中，开放手术和机器人手术治疗肾门肿瘤的患者，其达到低“三联征”结果的可能性相当，机器人组的平均住院时间更短。
