Takagi Toshio, Yoshida Kazuhiko, Kondo Tsunenori, Kobayashi Hirohito, Iizuka Junpei, Okumi Masayoshi, Ishida Hideki, Tanabe Kazunari
Department of Urology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
J Robot Surg. 2021 Feb;15(1):99-104. doi: 10.1007/s11701-020-01086-3. Epub 2020 May 1.
To compare the surgical outcomes between the transperitoneal (TP) and retroperitoneal (RP) approaches in robot-assisted laparoscopic partial nephrectomy (RAPN) for lateral tumors.
This study included patients who underwent RAPN for lateral renal tumors between 2013 and 2019. Lateral tumors were defined as X of A factors in the RENAL nephrometry score. In total, 290 and 48 patients with TP and RP, respectively, were included in the analysis. To minimize the effects of selection bias, the following variables were adjusted using 1:1 propensity score matching: age, sex, body mass index, American Society of Anesthesiologists score, preoperative estimated glomerular filtration rate, tumor size, and RENAL nephrometry score.
After matching, 48 patients were allocated to each group. The mean age was 55 years, and the mean preoperative estimated glomerular filtration rate (eGFR) was 68-69 mL/min/1.73 m. The mean tumor size was 30-31 mm. The RP group had a shorter operative time (124 vs. 151 min, p = 0.0002), shorter console time (74 vs. 110 min, p < 0.0001), shorter warm ischemic time (14 vs. 17 min, p = 0.0343), lower estimated blood loss (EBL) (33 vs. 52 ml, p = 0.0002), and shorter postoperative length of hospital stay (PLOS) (3.3 vs. 4.0 days, p < 0.0001) than the TP group. The change in eGFR, incidence rate of perioperative complication, and positive surgical margin rate did not significantly differ between the two groups.
RP had better surgical outcomes, including shorter operative time, lower EBL, and shorter PLOS for lateral renal tumors, which may suggest that RP is the optimal approach for selected lateral renal tumors.
比较经腹腔（TP）与腹膜后（RP）入路在机器人辅助腹腔镜肾部分切除术（RAPN）治疗外侧肿瘤中的手术效果。
本研究纳入了2013年至2019年间接受RAPN治疗外侧肾肿瘤的患者。外侧肿瘤定义为RENAL肾计量评分中的A因素X。分析共纳入290例TP患者和48例RP患者。为尽量减少选择偏倚的影响，使用1:1倾向评分匹配对以下变量进行了调整：年龄、性别、体重指数、美国麻醉医师协会评分、术前估计肾小球滤过率、肿瘤大小和RENAL肾计量评分。
匹配后，每组分配48例患者。平均年龄为55岁，术前平均估计肾小球滤过率（eGFR）为68 - 69 mL/min/1.73 m²。平均肿瘤大小为30 - 31 mm。与TP组相比，RP组手术时间更短（124 vs. 151分钟，p = 0.0002），控制台操作时间更短（74 vs. 110分钟，p < 0.0001），热缺血时间更短（14 vs. 17分钟，p = 0.0343），估计失血量（EBL）更低（33 vs. 52 ml，p = 0.0002），术后住院时间（PLOS）更短（3.3 vs. 4.0天，p < 0.0001）。两组间eGFR的变化、围手术期并发症发生率和手术切缘阳性率无显著差异。
对于外侧肾肿瘤，RP具有更好的手术效果，包括手术时间更短、EBL更低和PLOS更短，这可能表明RP是部分外侧肾肿瘤的最佳入路。
