Zhao Xiaozhi, Lu Qun, Campi Riccardo, Ji Changwei, Guo Suhan, Liu Guangxiang, Zhang Shiwei, Li Xiaogong, Gan Weidong, Minervini Andrea, Guo Hongqian
Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Nanjing, Jiangsu, People's Republic of China.
Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
Urology. 2018 Nov;121:97-103. doi: 10.1016/j.urology.2018.08.015. Epub 2018 Aug 28.
To compare perioperative results and early oncological outcomes of endoscopic robot-assisted simple enucleation (ERASE) and laparoscopic simple enucleation (LSE) by using a propensity score-matched analysis.
We evaluated 383 patients who underwent transperitoneal ERASE or LSE for renal tumors from November 2012 to October 2016. Propensity score matching was performed on age, gender, body mass index, Eastern Cooperative Oncology Group score, tumor side and size, preoperative estimated GFR and PADUA score.
In total, 278 and 105 patients underwent ERASE and LSE, respectively. The PADUA score was ≥10 for 61 (21.9%) and 13 (12.4%), respectively (P = .034). After matching, mean operative time and warm ischemic time were significantly lower with ERASE than LSE (171.9 vs 188.2 minutes; P = 0.016 and 20.9 vs 24.2 minutes; P = .001). The estimated mean blood loss was similar (167.7 vs 183.3 mL; P = .315). The conversion rate to open surgery or radical nephrectomy was similar with ERASE and LSE (1.0% vs 5.0%, P = .214) and the rate of intraoperative complications was lower (2.0% vs 8.9%, P = .030). The overall incidence of positive surgical margins was similar (P = .614). The median follow-up was less for ERASE than LSE patients (22 vs 38 months). Recurrence did not differ between the 2 groups: 2 ERASE cases (2.0%) versus 4 LSE cases (4.0%) (P = .679).
ERASE is a safe and acceptable alternative to LSE. ERASE appears to confer shorter operative time, shorter warm ischemic time and lower rate of intraoperative complication.
通过倾向评分匹配分析比较内镜机器人辅助单纯剜除术（ERASE）和腹腔镜单纯剜除术（LSE）的围手术期结果和早期肿瘤学结局。
我们评估了2012年11月至2016年10月期间接受经腹ERASE或LSE治疗肾肿瘤的383例患者。对年龄、性别、体重指数、东部肿瘤协作组评分、肿瘤侧别和大小、术前估计的肾小球滤过率和PADUA评分进行倾向评分匹配。
共有278例和105例患者分别接受了ERASE和LSE。PADUA评分≥10分的患者分别有61例（21.9%）和13例（12.4%）（P = 0.034）。匹配后，ERASE组的平均手术时间和热缺血时间显著低于LSE组（171.9分钟对188.2分钟；P = 0.016；20.9分钟对24.2分钟；P = 0.001）。估计平均失血量相似（167.7毫升对183.3毫升；P = 0.315）。ERASE组和LSE组转为开放手术或根治性肾切除术的比例相似（1.0%对5.0%，P = 0.214），术中并发症发生率较低（2.0%对8.9%，P = 0.030）。手术切缘阳性的总体发生率相似（P = 0.614）。ERASE组患者的中位随访时间短于LSE组患者（22个月对38个月）。两组之间的复发情况无差异：2例ERASE病例（2.0%）对4例LSE病例（4.0%）（P = 0.679）。
ERASE是LSE的一种安全且可接受的替代方法。ERASE似乎具有更短的手术时间、更短的热缺血时间和更低的术中并发症发生率。
