Division of Urology, VCU Health, Richmond, VA, USA.
Department of Urology, University of Bari, Bari, Italy.
Minerva Urol Nephrol. 2021 Aug;73(4):540-543. doi: 10.23736/S2724-6051.20.04151-X. Epub 2020 Nov 17.
The role of robot-assisted partial nephrectomy (RAPN) in the management of renal masses has exponentially grown over the past 10 years. Nevertheless, data on long term outcomes of the procedure remains limited. Herein we report oncological and functional outcomes of patients who underwent RAPN for a malignant mass with a median follow-up of 7 years, the longest follow-up to date.
A retrospective analysis of an international multicenter database was performed. All consecutive patients undergoing surgery between 2009 and 2013 with a minimum of 3-year follow-up and complete data on renal function were included. Demographics, surgical and perioperative outcomes were analyzed. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analysis.
Overall, our study cohort was composed of eighty-five patients with a median follow-up of 88 months. Median clinical tumor size was 3 cm, with mostly (74.1%) clinical stage T1a, and median RENAL score 6. Final histopathologic analysis revealed clear cell RCC in 76.5% of cases. PSM was present in seven patients (8.2%). Eleven overall deaths (12.9%) occurred in the cohort during the follow-up period. Two of these (2.33%) were attributed to metastatic RCC. The OS, CSS, and DFS rates were 91.7%, 97.7%, and 91.7% at 84 months, respectively. Regarding the renal functional outcomes, seventeen patients (20.1%) presented a CKD upstaging in our cohort.
Our findings show excellent 7-year oncologic and functional outcomes of the procedure, which duplicate those achieved in historical series of open and laparoscopic surgery.
过去 10 年来，机器人辅助部分肾切除术（RAPN）在处理肾肿瘤方面的作用呈指数级增长。然而，关于该手术的长期结果的数据仍然有限。在此，我们报告了中位随访时间为 7 年（目前为止最长的随访时间）的恶性肿瘤患者接受 RAPN 治疗的肿瘤学和功能结果。
对国际多中心数据库进行了回顾性分析。纳入了 2009 年至 2013 年间接受手术且至少有 3 年随访期和完整肾功能数据的连续患者。分析了人口统计学、手术和围手术期结果。使用 Kaplan-Meier 分析评估总生存期（OS）、无病生存期（DFS）和癌症特异性生存期（CSS）。
在我们的研究队列中，共有 85 例患者，中位随访时间为 88 个月。中位临床肿瘤大小为 3cm，大多数（74.1%）为临床分期 T1a，中位 RENAL 评分为 6 分。最终组织病理学分析显示 76.5%的病例为透明细胞肾细胞癌。在该队列中，7 例（8.2%）存在肾门周围组织侵犯。在随访期间，该队列中有 11 例患者（12.9%）死亡。其中 2 例（2.33%）归因于转移性肾细胞癌。在 84 个月时，OS、CSS 和 DFS 率分别为 91.7%、97.7%和 91.7%。关于肾功能结果，我们的队列中有 17 例（20.1%）出现 CKD 分期升级。
我们的研究结果表明，该手术在 7 年时具有出色的肿瘤学和功能结果，与开放和腹腔镜手术的历史系列结果相当。
