Dong Wen, Chen Xiong, Huang Ming, Chen Xu, Gao Ming, Ou Dehua, Li Kaiwen, Wang Chenyang, Wu Shaoxu, Liu Hao, Xie Weibin, Xie Wenlian, Campbell Steven C, Lin Tianxin, Huang Jian
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Front Oncol. 2021 Jan 14;10:595457. doi: 10.3389/fonc.2020.595457. eCollection 2020.
Tumor enucleation (TE) optimizes parenchymal preservation with promising short-term oncologic outcomes compared with standard partial nephrectomy (SPN). However, researches/literatures about long-term oncologic outcomes for TE after minimally invasive surgery are scarce. We aim to analyze long-term oncologic outcomes after laparoscopic and robotic tumor enucleation for renal cell carcinoma (RCC).
We retrospectively analyzed 146 patients who underwent TE with either laparoscopic or robotic approach for localized RCC in our center. Local recurrence, cancer specific survival (CSS), recurrence free survival (RFS), and overall survival (OS) were the main outcomes. Survival curves were generated using a Kaplan-Meier method. Perioperative outcomes and pathological outcomes were also analyzed.
Overall, 98 male and 48 female patients were eligible for the study. The median tumor size was 3.4 cm with a median R.E.N.A.L. score of seven. Warm ischemia was used in 143 patients with a median ischemia time of 20 min and three patients had zero ischemia. Five patients (3.4%) had major complications (> Clavien IIIa) and only two were related to urinary system. The median global glomerular filtration rate (GFR) preserved after surgery was 93%. Pseudocapsule invasion was reported in 50 tumors (34%) and positive surgical margins were found in 3/146 (2.1%) tumors. At a median follow-up of 66 months, local recurrence happened in two patients (1.4%), and systemic recurrence happened in six patients (4.2%). The 5-year CSS, RFS, OS were 95.7, 89.6, and 91.9%, and the 10-year CSS, RFS, OS were 93.8, 89.6, and 90.0%, respectively.
This study indicates that tumor enucleation with laparoscopic or robotic approach in experienced hands for the treatment of RCC appears oncologically safe with a median follow-up of more than 5 years. Prospective studies with more patients and longer follow-up will be required to further evaluate oncologic safety after TE.
与标准部分肾切除术（SPN）相比，肿瘤剜除术（TE）能优化实质保留，且短期肿瘤学结局良好。然而，关于微创手术后TE的长期肿瘤学结局的研究/文献较少。我们旨在分析腹腔镜和机器人辅助肾细胞癌（RCC）肿瘤剜除术后的长期肿瘤学结局。
我们回顾性分析了在本中心接受腹腔镜或机器人辅助TE治疗局限性RCC的146例患者。主要结局包括局部复发、癌症特异性生存（CSS）、无复发生存（RFS）和总生存（OS）。采用Kaplan-Meier方法生成生存曲线。还分析了围手术期结局和病理结局。
总体而言，98例男性和48例女性患者符合研究条件。肿瘤中位大小为3.4 cm，R.E.N.A.L.评分中位数为7分。143例患者采用了温缺血，中位缺血时间为20分钟，3例患者缺血时间为零。5例患者（3.4%）发生了严重并发症（>Clavien IIIa级），其中仅2例与泌尿系统有关。术后保留的肾小球滤过率（GFR）中位数为93%。50个肿瘤（34%）报告有假包膜侵犯，146个肿瘤中有3个（2.1%）发现手术切缘阳性。中位随访66个月时，2例患者（1.4%）发生局部复发，6例患者（4.2%）发生全身复发。5年CSS、RFS、OS分别为95.7%、89.6%和91.9%，10年CSS、RFS、OS分别为93.8%、89.6%和90.0%。
本研究表明，在经验丰富的医生手中，采用腹腔镜或机器人辅助方法进行RCC肿瘤剜除术在肿瘤学上似乎是安全的，中位随访时间超过5年。需要进行更多患者参与且随访时间更长的前瞻性研究，以进一步评估TE后的肿瘤学安全性。
