Tang Amber B, Lamaina Margherita, Childers Christopher P, Mak Selene S, Ruan Qiao, Begashaw Meron M, Bergman Jonathan, Booth Marika S, Shekelle Paul G, Wilson Mark, Gunnar William, Maggard-Gibbons Melinda, Girgis Mark D
12222Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
7171Veterans Health Administration, Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Am Surg. 2021 Jan;87(1):21-29. doi: 10.1177/0003134820948912. Epub 2020 Sep 9.
Adoption of the robotic surgical platform for small renal cancers has rapidly expanded, but its utility compared to other approaches has not been established. The objective of this review is to assess perioperative and long-term oncologic and functional outcomes of robot-assisted partial nephrectomy (RAPN) compared to laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN).
A search in PubMed, Embase, and Cochrane (2010-2019) was conducted. Of 3877 articles screened, 7 observational studies were included.
RAPN was associated with 24-50 mL less intraoperative blood loss compared to LPN and 39-84 mL less than OPN. RAPN also demonstrated trends of other postoperative benefits, such as shorter length of stay and fewer major complications. Several studies reported better long-term functional kidney outcomes, but these findings were inconsistent. Recurrence and cancer-specific survival (CSS) were similar across groups. While RAPN had a 5-year CSS of 90.1%-97.9%, LPN and OPN had survival rates of 85.9%-86.9% and 88.5-96.3% respectively.
RAPN may be associated with a lower estimated blood loss and comparable long-term outcomes when compared to other surgical approaches. However, additional randomized or propensity matched studies are warranted to fully assess long-term functional kidney and oncologic outcomes.
机器人手术平台在小肾癌治疗中的应用迅速扩大，但与其他手术方式相比，其效用尚未明确。本综述的目的是评估机器人辅助部分肾切除术（RAPN）与腹腔镜部分肾切除术（LPN）和开放部分肾切除术（OPN）相比的围手术期及长期肿瘤学和功能结局。
检索了PubMed、Embase和Cochrane数据库（2010 - 2019年）。在筛选的3877篇文章中，纳入了7项观察性研究。
与LPN相比，RAPN术中失血少24 - 50 mL，与OPN相比少39 - 84 mL。RAPN还显示出其他术后获益的趋势，如住院时间更短和主要并发症更少。几项研究报告了更好的长期肾功能结局，但这些结果并不一致。各组的复发率和癌症特异性生存率（CSS）相似。虽然RAPN的5年CSS为90.1% - 97.9%，但LPN和OPN的生存率分别为85.9% - 86.9%和88.5% - 96.3%。
与其他手术方式相比，RAPN可能术中估计失血量更低且长期结局相当。然而，需要更多的随机或倾向匹配研究来全面评估长期肾功能和肿瘤学结局。
