Larcher Alessandro, Wallis Christopher J D, Pavan Nicola, Porpiglia Francesco, Takagi Toshio, Tanabe Kazunari, Rha Koon H, Raheem Ali Abdel, Yang Bo, Zang Chao, Perdonà Sisto, Quarto Giuseppe, Maurer Tobias, Amiel Thomas, Schips Luigi, Castellucci Roberto, Crivellaro Simone, Dobbs Ryan, Baiamonte Gianfranco, Celia Antonio, De Concilio Bernardino, Furlan Maria, Lima Estevão, Linares Estefania, Micali Salvatore, Amparore Daniele, De Naeyer Geert, Trombetta Carlo, Hampton Lance J, Tracey Andrew, Bindayi Ahmet, Antonelli Alessandro, Derweesh Ithaar, Mir Carme, Montorsi Francesco, Mottrie Alexandre, Autorino Riccardo, Capitanio Umberto
Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy.
Department of Urology, OLV Hospital, Aalst, Belgium.
Cent European J Urol. 2020;73(3):273-279. doi: 10.5173/ceju.2020.0179. Epub 2020 Sep 8.
The aim of the study was to perform a comprehensive investigation of clinical outcomes of robot-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN) in elderly patients presenting with a renal mass. The REnal SURGery in Elderly (RESURGE) collaborative database was queried to identify patients aged 75 or older diagnosed with cT1-2 renal mass and treated with RAPN or LPN. Study outcomes were: overall complications (OC); warm ischemia time (WIT) and 6-month estimated glomerular filtration rate (eGFR); positive surgical margins (PSM), disease recurrence (REC), cancer-specific mortality (CSM) and other-cause mortality (OCM). Descriptive statistics, Kaplan-Meier, smoothed Poisson plots and logistic and linear regression models (MVA) were used. Overall, 216 patients were included in this analysis. OC rate was 34%, most of them being of low Clavien grade. Median WIT was 17 minutes and median 6-month eGFR was 54 ml/min/1.73 m. PSM rate was 5%. After a median follow-up of 20 months, the 5-year rates of REC, CSM and OCM were 4, 4 and 5%, respectively. At MVA predicting perioperative morbidity, RAPN relative to LPN (odds ratio [OR] 0.33; p <0.0001) was associated with lower OC rate. At MVA predicting functional outcomes, RAPN relative to LPN was associated with shorter WIT (estimate [EST] -4.09; p <0.0001), and with higher 6-month eGFR (EST 6.03; p = 0.01). In appropriately selected patients with small renal masses, minimally-invasive PN is associated with acceptable perioperative outcomes. The use of a robotic approach over a standard laparoscopic approach can be advantageous with respect to clinically relevant outcomes, and it should be preferred when available.
本研究的目的是对老年肾肿物患者行机器人辅助部分肾切除术（RAPN）或腹腔镜部分肾切除术（LPN）的临床结局进行全面调查。查询老年肾脏手术（RESURGE）协作数据库，以识别年龄在75岁及以上、诊断为cT1-2肾肿物并接受RAPN或LPN治疗的患者。研究结局包括：总体并发症（OC）、热缺血时间（WIT）和6个月估计肾小球滤过率（eGFR）；手术切缘阳性（PSM）、疾病复发（REC）、癌症特异性死亡率（CSM）和其他原因死亡率（OCM）。采用描述性统计、Kaplan-Meier法、平滑泊松图以及逻辑和线性回归模型（MVA）。总体而言，本分析纳入了216例患者。OC发生率为34%，其中大多数为低Clavien分级。中位WIT为17分钟，中位6个月eGFR为54 ml/min/1.73 m²。PSM发生率为5%。中位随访20个月后，REC、CSM和OCM的5年发生率分别为4%、4%和5%。在预测围手术期发病率的MVA中，与LPN相比，RAPN（优势比[OR] 0.33；p<0.0001）与较低的OC发生率相关。在预测功能结局的MVA中，与LPN相比，RAPN与较短的WIT相关（估计值[EST] -4.09；p<0.0001），且与较高的6个月eGFR相关（EST 6.03；p = 0.01）。在适当选择的小肾肿物患者中，微创部分肾切除术的围手术期结局可接受。与标准腹腔镜手术相比，采用机器人手术方法在临床相关结局方面可能具有优势，如有条件应优先选择。
