Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Department of Urology, SS Annunziata Hospital, "G.D'Annunzio" University of Chieti, Chieti, Italy.
World J Urol. 2019 Nov;37(11):2439-2450. doi: 10.1007/s00345-019-02657-2. Epub 2019 Feb 7.
To compare the outcomes of robotic radical nephrectomy (RRN) to those of laparoscopic radical nephrectomy (LRN) for large renal masses.
This was a retrospective analysis of RRN and LRN cases performed for large (≥ cT2) renal masses from 2004 to 2017 and collected in the multi-institutional international database (ROSULA: RObotic SUrgery for LArge renal masses). Peri-operative, functional, and oncologic outcomes were compared between each approach. Descriptive analyses were performed and presented as medians with interquartile ranges. Inverse probability of treatment weighting-adjusted multivariable analyses were used to identify predictors of peri-operative complications. Kaplan-Meier analysis and Cox regression models were used to assess survival outcomes.
A total of 941 patients (RRN = 404, LRN = 537) were identified. There was no difference in terms of gender, age, and clinical tumor size. Over the study period, RRN had an annual increase of 11.75% (95% CI [7.34, 17.01] p < 0.001) and LRN had an annual decline of 5.39% (95% CI [-6.94, -3.86] p < 0.001). Patients undergoing RRN had higher BMI (27.6 [IQR 24.8-31.1] vs. 26.5 [24.1-30.0] kg/m, p < 0.01). Operative duration was longer for RRN (185.0 [150.0-237.2] vs. 126 [90.8-180.0] min, p < 0.001). Length of stay was shorter for RRN (3.0 [2.0-4.0] vs. 5.0 [4.0-7.0] days, p < 0.001). RRN cases presented more advanced disease (higher pathologic staging [pT3-4 52.5 vs. 24.2%, p < 0.001], histologic grade [high grade 49.3 vs. 30.4%, p < 0.001], and rate of nodal disease [pN1 5.4 vs. 1.9%, p < 0.01]). Surgical approach did not represent an independent risk factor for peri-operative complications (OR 1.81 95% CI [0.97-3.39], adjusted p = 0.2). The main study limitation is the retrospective design.
This study represents the largest known multi-center comparison between RRN and LRN. The two procedures seem to offer similar peri-operative outcomes. Notably, RRN has been increasingly utilized, especially in the setting of more advanced and surgically challenging disease without increasing the risk of peri-operative complications.
比较机器人辅助根治性肾切除术（RRN）与腹腔镜根治性肾切除术（LRN）治疗大肾肿瘤的疗效。
这是一项回顾性分析，纳入了 2004 年至 2017 年在国际多机构数据库（ROSULA：机器人手术治疗大肾肿瘤）中接受治疗的大（≥cT2）肾肿瘤患者的 RRN 和 LRN 病例。比较了两种方法的围手术期、功能和肿瘤学结果。采用描述性分析，结果表示为中位数和四分位距。采用逆概率治疗加权调整多变量分析确定围手术期并发症的预测因素。采用 Kaplan-Meier 分析和 Cox 回归模型评估生存结果。
共纳入 941 例患者（RRN=404 例，LRN=537 例）。两组患者的性别、年龄和临床肿瘤大小无差异。在研究期间，RRN 的年增长率为 11.75%（95%CI[7.34，17.01]，p<0.001），LRN 的年下降率为 5.39%（95%CI[-6.94，-3.86]，p<0.001）。接受 RRN 的患者 BMI 更高（27.6[IQR 24.8-31.1]vs.26.5[24.1-30.0]kg/m2，p<0.01）。RRN 的手术时间更长（185.0[150.0-237.2]vs.126[90.8-180.0]min，p<0.001）。RRN 的住院时间更短（3.0[2.0-4.0]vs.5.0[4.0-7.0]d，p<0.001）。RRN 病例的疾病分期更高（病理分期更高[pT3-4 52.5% vs.24.2%，p<0.001]，组织学分级更高[高级别 49.3% vs.30.4%，p<0.001]，淋巴结疾病的发生率更高[pN1 5.4% vs.1.9%，p<0.01]）。手术方式不是围手术期并发症的独立危险因素（OR 1.81，95%CI[0.97-3.39]，调整后 p=0.2）。本研究的主要局限性是回顾性设计。
这是迄今为止最大的 RRN 与 LRN 多中心比较研究。这两种手术似乎提供了相似的围手术期结果。值得注意的是，RRN 的应用越来越广泛，尤其是在更晚期和手术挑战性更大的疾病中，且并未增加围手术期并发症的风险。
