Department of Urology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium.
Eur Urol. 2019 Aug;76(2):222-227. doi: 10.1016/j.eururo.2018.11.038. Epub 2018 Dec 5.
Robot-assisted partial nephrectomy (RAPN) is considered a feasible minimally invasive alternative to open partial nephrectomy (OPN) for the surgical treatment of renal tumors.
To provide further evidence supporting the effectiveness of RAPN in a contemporary patient population treated at one of three tertiary care centers for robotic surgery and to describe the evolution of RAPN-based technical improvements.
DESIGN, SETTING, AND PARTICIPANTS: The Transatlantic Robotic Nephron-sparing Surgery (TRoNeS) study group prospectively collected data from 635 patients subjected to RAPN for clinically localized kidney cancer between 2010 and 2016 at three high-volume tertiary care centers.
RAPN was performed using methods outlined in the supplementary video using either the da Vinci Si or Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA).
Clinical data were collected within a prospectively maintained multi-institutional database. Intra- and postoperative data as well as surgical outcomes were assessed. Descriptive statistical analysis was performed and multivariable logistic regression models were fitted to determine the predictors of surgical outcomes.
Mean patient age was 60.7yr and mean preoperative tumor size was 33mm. According to the PADUA score, 202 (31.8%) patients had a low-, 235 (37.0%) had an intermediate-, and 198 (31.2%) had a high-complexity tumor. In the majority of patients, a transperitoneal approach was used (n=447; 70.4%). Mean operative time was 156.3min and mean estimated blood loss was 171ml. Overall, 25 (3.9%) patients experienced a significant (Clavien-Dindo >2) complication after surgery. No statistically significant differences between pre- and postoperative creatinine values were observed (p≤0.823). Finally, optimal surgical outcomes defined according to the margin, ischemia, and complication score were achieved in 459 (72.3%) individuals. At a mean follow-up of 26mo, only two local and two distant recurrences of the disease were observed. Finally, in multivariable logistic regression models, tumor complexity was associated with the risk of not achieving optimal surgical outcomes.
RAPN represents an effective minimally invasive alternative to OPN in the treatment of clinically localized renal tumors.
We reported contemporary experience with RAPN for the treatment of kidney cancer. RAPN appears to be a safe and effective procedure, resulting in optimal outcomes in the majority of individuals despite tumor complexity.
机器人辅助部分肾切除术（RAPN）被认为是治疗肾肿瘤的一种可行的微创替代开放部分肾切除术（OPN）的方法。
为了在三家机器人手术的三级护理中心之一治疗的当代患者人群中提供进一步支持 RAPN 有效性的证据，并描述 RAPN 为基础的技术改进的演变。
设计、设置和参与者：Transatlantic Robotic Nephron-sparing Surgery（TRoNeS）研究小组前瞻性地收集了 2010 年至 2016 年间在三家高容量三级护理中心接受 RAPN 治疗的 635 例临床局限性肾癌患者的数据。
RAPN 使用补充视频中概述的方法进行，使用达芬奇 Si 或 Xi 手术系统（Intuitive Surgical，加利福尼亚州森尼韦尔）。
临床数据在一个前瞻性维护的多机构数据库中收集。评估术中、术后数据和手术结果。进行描述性统计分析，并拟合多变量逻辑回归模型以确定手术结果的预测因素。
患者平均年龄为 60.7 岁，术前肿瘤平均大小为 33mm。根据 PADUA 评分，202 例（31.8%）患者为低复杂性肿瘤，235 例（37.0%）为中复杂性肿瘤，198 例（31.2%）为高复杂性肿瘤。在大多数患者中，采用经腹腔途径（n=447；70.4%）。平均手术时间为 156.3 分钟，平均估计失血量为 171ml。总体而言，25 例（3.9%）患者术后发生严重（Clavien-Dindo >2）并发症。术后血肌酐值无统计学显著差异（p≤0.823）。最后，根据边缘、缺血和并发症评分，459 例（72.3%）患者达到了最佳手术效果。在平均 26 个月的随访中，仅观察到 2 例局部和 2 例远处疾病复发。最后，在多变量逻辑回归模型中，肿瘤复杂性与未达到最佳手术效果的风险相关。
RAPN 是治疗临床局限性肾肿瘤的 OPN 的有效微创替代方法。
我们报告了 RAPN 治疗肾癌的当代经验。尽管肿瘤复杂，但 RAPN 似乎是一种安全有效的手术，大多数患者的手术结果都很理想。
