Heinze Alexander, Larcher Alessandro, Umari Paolo, Fossati Nicola, Piccolo Joey, De Groote Ruben, Goossens Marijn, De Coninck Vincent, De Naeyer Geert, Mottrie Alexandre
Department of Urology, OLV Ziekenhuis, Aalst, Belgium.
School of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico.
Int J Urol. 2018 Sep;25(9):826-831. doi: 10.1111/iju.13754. Epub 2018 Aug 21.
To determine the impact of imperative or elective indications on the perioperative, functional and oncological outcomes of patients undergoing robot-assisted partial nephrectomy.
Between June 2006 and September 2016, data of patients who underwent robot-assisted partial nephrectomy at the Onze-Lieve-Vrouwziekenhuis Hospital in Aalst, Belgium, were retrospectively reviewed from a prospectively collected database. Only patients with non-metastatic, clinical T1-T2 graded tumors were included. Perioperative, functional and oncological outcomes were recollected. A comparative analysis was carried out after dividing patients into two groups: those who underwent robot-assisted partial nephrectomy for an elective indication (group 1, n = 194), and for an imperative indication (group 2, n = 57) caused by a solitary kidney (n = 20), impaired renal function (n = 2) or both (n = 35).
Patients in group 2 were older (74 vs 71 years, P < 0.001), and had a higher Charlson Comorbidity Index (P < 0.001) and American Society of Anesthesiologists score (P < 0.001). No differences were observed concerning laterality, sex, preoperative aspects and dimensions used for an anatomical score or clinical stage. Surgical outcomes considering estimated blood loss, surgical time, ischemia time and transfusion rate showed no significant difference between groups. The complication rate according to Clavien-Dindo showed no difference between groups (P = 0.6). No difference was found between groups with regard to percentage decrease of estimated glomerular filtration rate (7.4 vs 4.8%, P < 0.15).
Robot-assisted partial nephrectomy can be safely and effectively carried out by experienced surgeons in a high-volume center with similar perioperative, functional and oncological outcomes for both elective or imperative indications.
确定必要指征或择期指征对接受机器人辅助肾部分切除术患者围手术期、功能及肿瘤学结局的影响。
回顾性分析2006年6月至2016年9月在比利时阿尔斯特的翁泽-利夫-弗劳维肯huis医院接受机器人辅助肾部分切除术患者的数据，这些数据来自前瞻性收集的数据库。仅纳入非转移性、临床T1-T2级肿瘤患者。收集围手术期、功能及肿瘤学结局。将患者分为两组进行比较分析：一组因择期指征接受机器人辅助肾部分切除术（第1组，n = 194），另一组因必要指征接受手术（第2组，n = 57），必要指征包括孤立肾（n = 20）、肾功能受损（n = 2）或两者皆有（n = 35）。
第2组患者年龄更大（74岁对71岁，P < 0.001），Charlson合并症指数更高（P < 0.001），美国麻醉医师协会评分更高（P < 0.001）。在患侧、性别、术前情况以及用于解剖评分或临床分期的维度方面未观察到差异。考虑估计失血量、手术时间、缺血时间和输血率的手术结局在两组间无显著差异。根据Clavien-Dindo分级的并发症发生率在两组间无差异（P = 0.6）。两组间估计肾小球滤过率下降百分比无差异（7.4%对4.8%，P < 0.15）。
经验丰富的外科医生在高容量中心能够安全有效地实施机器人辅助肾部分切除术，对于择期或必要指征患者，围手术期、功能及肿瘤学结局相似。
