Paulucci David J, Beksac Alp Tuna, Porter James, Abaza Ronney, Eun Daniel D, Bhandari Akshay, Hemal Ashok K, Badani Ketan K
1 Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York.
2 Department of Urology, Swedish Urology Group, Seattle, Washington.
J Laparoendosc Adv Surg Tech A. 2019 Jan;29(1):29-34. doi: 10.1089/lap.2018.0313. Epub 2018 Aug 14.
To compare the perioperative and renal functional outcome between transperitoneal and retroperitoneal robotic partial nephrectomy (TP-RPN and RP-RPN) in the largest cohort to date of RP-RPN for posterior tumors.
We identified 519 patients who met eligibility criteria and underwent TP-RPN (n = 357, 68.8%) or RP-RPN (n = 162, 31.2%) for a posteriorly located cT1 tumor. Patients were propensity score (PS) matched on preoperative and tumor-specific characteristics. Perioperative outcome and renal function outcome at median follow-up 22 months were compared.
Between the PS matched TP-RPN (n = 157, 50%) and RP-RPN (n = 157, 50%) patients, operative time (OT) (185.0 versus 157.0, P < .001) was longer in TP-RPN versus RP-RPN patients. No significant differences in ischemia time (P = .618), blood loss (P = .178), positive surgical margins (P = .501), overall postoperative complications (P = .861), or progression of chronic kidney disease stage at median 22 months (P = .599) were identified. Length of stay (LOS) was reduced in RP-RPN patients (P = .017), but was not different once an institution used a postoperative day (POD)-1 discharge protocol (P = .579). Operative times were similar between groups in patients with obesity (P = .293) or a cT1b renal mass (P = 908).
RP-RPN for posterior tumors resulted in reduced OT and a shorter LOS compared to TP-RPN. When surgeons aimed to routinely discharge patients on POD-1, the surgical approach did not influence LOS. Operative time was similar between RP and TP-RPN among patients with obesity or a cT1b renal mass. All other measures, including ischemia time, blood loss, margin rates, complications, and renal function, did not differ between the two approaches.
在迄今为止最大规模的后位肿瘤腹膜后机器人辅助肾部分切除术（RP-RPN）队列中，比较经腹机器人辅助肾部分切除术（TP-RPN）和腹膜后机器人辅助肾部分切除术（RP-RPN）的围手术期及肾功能结果。
我们确定了519例符合入选标准并因后位cT1肿瘤接受TP-RPN（n = 357，68.8%）或RP-RPN（n = 162，31.2%）的患者。根据术前和肿瘤特异性特征对患者进行倾向评分（PS）匹配。比较中位随访22个月时的围手术期结果和肾功能结果。
在PS匹配的TP-RPN组（n = 157，50%）和RP-RPN组（n = 157，50%）患者中，TP-RPN组患者的手术时间（OT）（185.0对157.0，P <.001）比RP-RPN组更长。在缺血时间（P = .618）、失血量（P = .178）、手术切缘阳性率（P = .501）、总体术后并发症（P = .861）或中位22个月时慢性肾脏病分期进展（P = .599）方面未发现显著差异。RP-RPN组患者的住院时间（LOS）缩短（P = .017），但一旦机构采用术后第1天出院方案，住院时间无差异（P = .579）。肥胖患者（P = .293）或cT1b肾肿物患者（P = 908）组间手术时间相似。
与TP-RPN相比，后位肿瘤的RP-RPN导致手术时间缩短和住院时间缩短。当外科医生旨在常规术后第1天出院患者时，手术方式不影响住院时间。肥胖患者或cT1b肾肿物患者中，RP-RPN和TP-RPN的手术时间相似。包括缺血时间、失血量、切缘率、并发症和肾功能在内的所有其他指标在两种手术方式之间无差异。
