Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
Int J Urol. 2019 Jul;26(7):745-751. doi: 10.1111/iju.14004. Epub 2019 Apr 18.
To evaluate the change in the operated parenchymal volume during robot-assisted partial nephrectomy limited to the enucleation technique, and to analyze the predictors of decrease in operated parenchymal volume, including the tumor contact surface area.
The study included 135 patients who underwent robot-assisted partial nephrectomy for T1 renal tumors using the enucleation technique. Measurements of the parenchymal volume, tumor volume and contact surface area were obtained in the venous phase on enhanced computed tomography. All measurements, including volumetric and renal function analysis, were carried out <2 months before and 6 months after surgery.
The mean age of included participants was 56 years, and the mean tumor size was 33 mm. The mean tumor volume was 26 cc, and the mean contact surface area was 22 cm . In the complete cohort, the mean preoperative and postoperative normal parenchymal volumes of the operated kidney were 158 and 141 cc, respectively. The mean change in parenchymal volume of the operated kidney was -10%. In contrast, the mean change in global estimated glomerular filtration was just -4.0%. Univariate analysis showed that the RENAL nephrometry score, contact surface area, tumor volume and warm ischemia time were associated with the change in the operated kidney parenchymal volume. However, in the multivariate analysis, a large contact surface area was the only independent predictor of decreased operated parenchymal volume <10 cm .
Contact surface area is a strong predictor of the decrease in the parenchymal volume in the operated kidney during robot-assisted partial nephrectomy carried out using the enucleation technique for T1 renal tumors.
评估限于剜除技术的机器人辅助部分肾切除术过程中切除的实质体积的变化，并分析导致切除的实质体积减少的预测因素，包括肿瘤接触表面积。
本研究纳入了 135 名因 T1 肾肿瘤接受机器人辅助部分肾切除术的患者，这些患者均采用剜除技术。在增强 CT 的静脉期对实质体积、肿瘤体积和接触表面积进行测量。所有测量值，包括体积和肾功能分析，均在手术前 <2 个月和手术后 6 个月进行。
纳入患者的平均年龄为 56 岁，平均肿瘤大小为 33mm。肿瘤平均体积为 26cc，平均接触表面积为 22cm 。在完整队列中，手术肾脏的术前和术后正常实质体积平均值分别为 158 和 141cc。手术肾脏实质体积的平均变化为-10%。相比之下，全球估计肾小球滤过率的平均变化仅为-4.0%。单因素分析显示，肾肿瘤 RENAL 评分、接触面积、肿瘤体积和热缺血时间与手术肾脏实质体积的变化相关。然而，在多因素分析中，大的接触面积是导致剜除 T1 肾肿瘤时手术肾脏实质体积减少<10cm 的唯一独立预测因素。
接触面积是采用剜除技术的机器人辅助部分肾切除术中切除的手术肾脏实质体积减少的强有力预测因素。
