Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; ORSI, Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.
Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium.
Eur Urol Oncol. 2021 Feb;4(1):112-116. doi: 10.1016/j.euo.2018.12.010. Epub 2019 Jan 22.
Available comparison of transperitoneal robot-assisted partial nephrectomy (tRAPN) and retroperitoneal robot-assisted partial nephrectomy (rRAPN) does not consider tumour's location. The aim of this study was to compare perioperative morbidity, and functional and pathological outcomes after tRAPN and rRAPN, with the specific hypothesis that tRAPN for anterior tumours and rRAPN for posterior tumours might be a beneficial strategy. A large global collaborative dataset of 1169 cT1-2N0M0 patients was used. Propensity score matching, and logistic and linear regression analyses tested the effect of tRAPN versus rRAPN on perioperative outcomes. No differences were observed between rRAPN and tRAPN with respect to complications, operative time, length of stay, ischaemia time, median 1-yr estimated glomerular filtration rate (eGFR), and positive surgical margins (all p>0.05). Median estimated blood loss and postoperative eGFR were 50 versus100ml (p<0.0001) and 82 versus 78ml/min/1.73 m (p=0.04) after rRAPN and tRAPN, respectively. At interaction tests, no advantage was observed after tRAPN for anterior tumours and rRAPN for posterior tumours with respect to complications, warm ischaemia time, postoperative eGFR, and positive surgical margins (all p>0.05). The techniques of rRAPN and tRAPN offer equivalent perioperative morbidity, and functional and pathological outcomes, regardless of tumour's location. PATIENT SUMMARY: Robot-assisted partial nephrectomy can be performed with a transperitoneal or a retroperitoneal approach regardless of the specific position of the tumour, with equivalent outcomes for the patient.
现有的经腹腔机器人辅助部分肾切除术（tRAPN）和经腹膜后机器人辅助部分肾切除术（rRAPN）的比较并未考虑肿瘤的位置。本研究旨在比较 tRAPN 和 rRAPN 术后围手术期发病率以及功能和病理结果，并提出一个具体假设，即对于前位肿瘤采用 tRAPN，后位肿瘤采用 rRAPN 可能是一种有益的策略。该研究使用了一个包含 1169 例 cT1-2N0M0 患者的大型全球协作数据集。采用倾向评分匹配、逻辑和线性回归分析，检验了 tRAPN 与 rRAPN 对围手术期结果的影响。rRAPN 和 tRAPN 在并发症、手术时间、住院时间、缺血时间、中位 1 年估计肾小球滤过率（eGFR）和阳性切缘（所有 p>0.05）方面无差异。rRAPN 和 tRAPN 的中位估计失血量和术后 eGFR 分别为 50ml 和 100ml（p<0.0001）和 82ml/min/1.73m 和 78ml/min/1.73m（p=0.04）。在交互测试中，对于前位肿瘤采用 tRAPN 和后位肿瘤采用 rRAPN，在并发症、热缺血时间、术后 eGFR 和阳性切缘方面均未观察到优势（所有 p>0.05）。rRAPN 和 tRAPN 技术可用于治疗肿瘤的特定位置，无论肿瘤的位置如何，都能获得相似的围手术期发病率以及功能和病理结果。
机器人辅助部分肾切除术可经腹腔或腹膜后途径进行，无论肿瘤的位置如何，对患者的结果都是等效的。
