Vartolomei Mihai D, Matei Deliu V, Renne Giuseppe, Tringali Valeria M, Crișan Nicolae, Musi Gennaro, Mistretta Francesco A, Russo Andrea, Conti Andrea, Cozzi Gabriele, Luzzago Stefano, Catellani Michele, Cioffi Antonio, Cordima Giovanni, Bianchi Roberto, Di Trapani Ettore, Serino Alessandro, Delor Maurizio, Bianco Raffaele, Bottero Danilo, Ferro Matteo, De Cobelli Ottavio
Department of Urology, European Institute of Oncology, Milan, Italy.
Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania.
Minerva Urol Nefrol. 2019 Feb;71(1):31-37. doi: 10.23736/S0393-2249.18.03006-0. Epub 2018 Sep 19.
The aim of this study was to assess the long-term oncologic and functional outcomes in elderly patients having undergone robot-assisted partial nephrectomy (RAPN) for renal cancer (RC).
Sixty-one patients out of 323 who underwent RAPN for localized RC between July 2009 and March 2016 in our high-volume robotic surgery center (>800 procedures/year), had 70 years or more. Inclusion criteria of the study were age ≥70 years; pathological confirmed RCC and ASA Score ≤3. All patients were stratified according to PADUA classification system in three groups: <7 points, 8-9 points, >10 points. Trifecta was defined as a warm ischemia time (WIT) less then 25 min, negative surgical margins and no perioperative complications.
A total of 52 patients were included; median follow-up was 47 months. Median age was 74 yrs. (IQR 72-76.5). Complication rate was 15.4%. Trifecta failure was associated to PADUA Score (P=0.02), and tumor diameter (P=0.04). Renal function was altered in 10 (19.2%) patients before surgery and at last follow-up in 11 (21.1%) patients (CKD stage>2) The DFS, OS and CSS were 89.33%, 90.06% and 94.4%, respectively.
In a high-volume center, robot-assisted approach is feasible and safe in surgical fit elderly patients with good long-term oncologic outcomes.
本研究旨在评估老年肾癌患者接受机器人辅助部分肾切除术（RAPN）后的长期肿瘤学和功能结局。
2009年7月至2016年3月期间，在我们这个高容量机器人手术中心（每年手术量>800例）接受RAPN治疗局限性肾癌的323例患者中，61例年龄在70岁及以上。本研究的纳入标准为年龄≥70岁；病理确诊为肾细胞癌且美国麻醉医师协会（ASA）评分≤3分。所有患者根据帕多瓦（PADUA）分类系统分为三组：<7分、8 - 9分、>10分。三联成功定义为热缺血时间（WIT）少于25分钟、手术切缘阴性且无围手术期并发症。
共纳入52例患者；中位随访时间为47个月。中位年龄为74岁（四分位间距72 - 76.5岁）。并发症发生率为15.4%。三联成功失败与PADUA评分（P = 0.02）和肿瘤直径（P = 0.04）相关。10例（19.2%）患者术前肾功能异常，末次随访时11例（21.1%）患者肾功能异常（慢性肾脏病分期>2期）。无病生存率（DFS）、总生存率（OS）和癌症特异性生存率（CSS）分别为89.33%、90.06%和94.4%。
在高容量中心，机器人辅助手术方法对于手术适合的老年患者是可行且安全的，长期肿瘤学结局良好。
