Klinik für Urologie, Luzerner Kantonsspital, Luzern, Switzerland.
Klinik für Radiologie, Luzerner Kantonsspital, Luzern, Switzerland.
J Endourol. 2020 Aug;34(8):847-855. doi: 10.1089/end.2020.0143. Epub 2020 Jul 16.
Laparoscopic partial nephrectomy (LPN) and robot-assisted partial nephrectomy (RAPN) are commonly used techniques for treating small renal masses. Regarding renal function (RF) preservation, no superiority of one technique over the other has yet been definitely demonstrated. To compare functional and surgical outcomes of LPN and RAPN. Between 2015 and 2019, we prospectively randomized 115 patients with cT1-T2 renal masses to LPN in total ischemia or RAPN in selective ischemia. Primary endpoint was RF preservation, assessed by renal scintigraphy (RS). RS assessments were performed preoperatively and at 6 months follow-up. Secondary endpoints included clinical, histopathologic, and surgical outcomes. One hundred eight patients were included in the final analysis. Patient and tumor characteristics were comparable. No significant difference in RS values after 6 months was observed between both groups. Median (interquartile range) RF change after 6 months was -18.0% (-26.5 to -11.0) in LPN group and -20.0 (-33.2 to -12.0) in RAPN group ( = 0.3). Mean (standard deviation [SD]) warm ischemia time was 21.1 (6.1) minutes in LPN group and 19.6 (7.7) minutes in RAPN group ( = 0.2). No positive surgical margins (PSMs) occurred in the LPN group, whereas RAPN group had PSM in 4.9% ( = 3); = 0.099. Renal volume loss after 6 months was 27.5% (22.7-45.7) in the LPN group 37.5 (13.7-54.2) in the RAPN group ( = 0.5). Mean operative times were lower in the LPN group (192.3 minutes [SD 44.5] 230.2 minutes [SD 59.6], = 0.001). More complications occurred in the LPN group (31% 21%, = 0.075). Transfusion rates were 15% for LPN and 11% for RAPN. In terms of preserving RF, LPN in total ischemia and RAPN in selective ischemia are comparable. In most patients, RF decrease of the affected kidney after PN seems to not exceed 25%, regardless of the surgical approach.
腹腔镜部分肾切除术（LPN）和机器人辅助部分肾切除术（RAPN）是治疗小肾肿瘤的常用技术。关于肾功能（RF）的保护，还没有明确证明一种技术比另一种技术更优越。比较 LPN 和 RAPN 的功能和手术结果。2015 年至 2019 年，我们前瞻性地随机将 115 例 cT1-T2 肾肿瘤患者分为完全缺血 LPN 组和选择性缺血 RAPN 组。主要终点是通过肾闪烁显像（RS）评估的 RF 保留。术前和术后 6 个月进行 RS 评估。次要终点包括临床、组织病理学和手术结果。108 例患者纳入最终分析。患者和肿瘤特征具有可比性。两组术后 6 个月 RS 值无显著差异。LPN 组术后 6 个月 RF 变化中位数（四分位距）为-18.0%（-26.5 至-11.0），RAPN 组为-20.0%（-33.2 至-12.0）（ = 0.3）。LPN 组平均（标准差[SD]）热缺血时间为 21.1（6.1）分钟，RAPN 组为 19.6（7.7）分钟（ = 0.2）。LPN 组无阳性切缘（PSM），RAPN 组有 4.9%（ = 0.099）有 PSM。术后 6 个月 LPN 组肾体积丢失 27.5%（22.7-45.7），RAPN 组丢失 37.5%（13.7-54.2）（ = 0.5）。LPN 组的平均手术时间较低（192.3 分钟[SD 44.5] 230.2 分钟[SD 59.6]， = 0.001）。LPN 组并发症发生率较高（31% 21%， = 0.075）。LPN 组输血率为 15%，RAPN 组为 11%。在保留 RF 方面，完全缺血的 LPN 和选择性缺血的 RAPN 是可比的。在大多数患者中，PN 后受影响肾脏的 RF 下降似乎不超过 25%，无论手术方式如何。
