Jabaji Ramzi B, Fischer Heidi, Kern Tyler, Chien Gary W
Los Angeles Medical Center, CA.
Research and Evaluation for Kaiser Permanente in Pasadena, CA.
Perm J. 2019;23:18-108. doi: 10.7812/TPP/18-108.
Rapid adoption of robotics has introduced a paradigm change in prostate cancer treatment, with more than 80% of prostatectomies performed robotically in 2015. For treatment of renal cell carcinoma (RCC), this change has not previously been reported. We evaluated trends in surgical management of RCC in Kaiser Permanente Southern California (KPSC) within the last 16 years, especially after adoption of robotics.
From January 1999 to September 2015, all KPSC members who underwent surgical treatment of suspected RCC were included retrospectively. Surgical approach, patient age, sex, clinicopathology, Charlson Comorbidity Index, and chronic kidney disease status were analyzed using robust Poisson multivariate regression.
The study included 5237 patients. Partial nephrectomy was increasingly used during the study period, and its use surpassed radical nephrectomy in 2012. In a multivariate model, partial nephrectomy was associated with lower pathologic tumor stage (p < 0.001) and lower Charlson Comorbidity Index (p = 0.004) vs radical nephrectomy. Robot-assisted laparoscopic partial nephrectomy (RALPN) started in KPSC in March 2011, and its relative use among all RCC surgeries increased in the following 3 years by 125%, 45%, and 14%. Laparoscopic partial nephrectomy and laparoscopic radical nephrectomy were the most frequently used surgical approaches for localized RCC when RALPN started in 2011. However, RALPN surpassed laparoscopic partial nephrectomy and laparoscopic radical nephrectomy in 2012 and 2014, respectively.
During our study, partial nephrectomy became the most common surgery for treatment of localized RCC. Since 2014, RALPN has become the most common renal oncologic surgical modality in KPSC.
机器人技术的迅速应用给前列腺癌治疗带来了范式转变，2015年超过80%的前列腺切除术是通过机器人进行的。对于肾细胞癌（RCC）的治疗，此前尚未报道过这种变化。我们评估了南加州凯撒医疗集团（KPSC）在过去16年中肾细胞癌手术治疗的趋势，尤其是在采用机器人技术之后。
回顾性纳入1999年1月至2015年9月期间所有接受疑似肾细胞癌手术治疗的KPSC成员。使用稳健的泊松多变量回归分析手术方式、患者年龄、性别、临床病理、查尔森合并症指数和慢性肾病状态。
该研究纳入了5237例患者。在研究期间，部分肾切除术的使用越来越多，其使用量在2012年超过了根治性肾切除术。在多变量模型中，与根治性肾切除术相比，部分肾切除术与较低的病理肿瘤分期（p < 0.001）和较低的查尔森合并症指数（p = 0.004）相关。机器人辅助腹腔镜部分肾切除术（RALPN）于2011年3月在KPSC开展，在随后3年中，其在所有肾细胞癌手术中的相对使用量分别增加了125%、45%和14%。2011年RALPN开展时，腹腔镜部分肾切除术和腹腔镜根治性肾切除术是局限性肾细胞癌最常用的手术方式。然而，RALPN分别在2012年和2014年超过了腹腔镜部分肾切除术和腹腔镜根治性肾切除术。
在我们的研究期间，部分肾切除术成为局限性肾细胞癌最常见的手术方式。自2014年以来，RALPN已成为KPSC最常见的肾脏肿瘤手术方式。
