Department of Urology, University of Health Sciences, Dişkapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
Int Braz J Urol. 2020 May-Jun;46(3):341-350. doi: 10.1590/S1677-5538.IBJU.2018.0865.
This study aims to evaluate the oncological and functional results of open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN) at the T1b clinical stage, which constitutes 25% of renal cell carcinomas (RCC) at diagnosis.
The characteristics of 63 patients with stage T1b solitary tumor who underwent OPN (41) or LPN (22) were compared. The survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the factors affecting disease-free survival. Potential predictive factors, which might affect the postoperative glomerular filtration rate (GFR), were evaluated using multivariate linear regression analysis.
No differences were observed between OPN and LPN groups regarding patient and tumor characteristics. Although the warm ischemia time, intraoperative estimated blood loss, and operation duration were higher in the LPN group, no differences were noted between the two techniques regarding complication rates (p<0.001, p=0.023, p≤0.001, and p=0.190, respectively). The median hospitalization time was shorter in the LPN group than that in the OPN group (4 and 5 days, respectively), with less severe complications. No intergroup differences were observed regarding cancer-specific survival (CSS), disease-free survival (DFS), and overall survival (OS). The evaluation of the factors affecting DFS showed that age was an effective parameter (RR = 1.112, 95% CI: 1.010-8.254), but the surgical technique was not.
No differences were observed between OPN and LPN techniques between oncological and functional outcomes in patients with clinical stage T1b RCC.
本研究旨在评估 T1b 期局限性肾细胞癌（RCC）占诊断时 RCC 25%的开放式部分肾切除术（OPN）和腹腔镜部分肾切除术（LPN）的肿瘤学和功能结果。
比较了 63 例 T1b 期孤立肿瘤患者接受 OPN（41 例）或 LPN（22 例）的特征。采用 Kaplan-Meier 方法进行生存分析。采用单因素和多因素 Cox 回归分析确定影响无病生存率的因素。采用多元线性回归分析评估可能影响术后肾小球滤过率（GFR）的潜在预测因素。
OPN 和 LPN 组在患者和肿瘤特征方面无差异。虽然 LPN 组的热缺血时间、术中估计失血量和手术时间较高，但两种技术的并发症发生率无差异（p<0.001、p=0.023、p≤0.001 和 p=0.190）。LPN 组的中位住院时间短于 OPN 组（分别为 4 天和 5 天），且并发症较轻。两组之间在癌症特异性生存率（CSS）、无病生存率（DFS）和总生存率（OS）方面无差异。DFS 影响因素的评估显示，年龄是一个有效的参数（RR=1.112，95%CI：1.010-8.254），但手术技术不是。
在 T1b 期 RCC 患者中，OPN 和 LPN 技术在肿瘤学和功能结果方面无差异。
