Mellouki Adil, Bentellis Imad, Morrone Arnoult, Doumerc Nicolas, Beauval Jean-Baptiste, Roupret Morgane, Nouhaud François-Xavier, Lebacle Cedric, Long Jean-Alexandre, Chevallier Daniel, Tibi Brannwel, Shaikh Aysha, Imbert de la Phalecque L, Pillot Pierre, Tillou Xavier, Bernhard Jean-Christophe, Durand Matthieu, Ahallal Youness
Department of Urology, Andrology and Renal Transplant, Pasteur II University Hospital, 30 Avenue Romaine, 06001, Nice, France.
Department of Urology, University Hospital of Toulouse, Toulouse, France.
World J Urol. 2023 Feb;41(2):287-294. doi: 10.1007/s00345-020-03558-5. Epub 2021 Feb 19.
To compare off-clamp vs on-clamp robotic partial nephrectomy (RPN) for renal cell carcinoma (RCC) in terms of oncological outcomes, and to assess the impact of surgical experience (SE).
We extracted data of a contemporary cohort of 1359 patients from the prospectively maintained database of the French national network of research on kidney cancer (UROCCR). The primary objective was to assess the positive surgical margin (PSM) rate. We also evaluated the oncological outcomes regardless of the surgical experience (SE) by dividing patients into three groups of SE as a secondary endpoints. SE was defined by the caseload of RPN per surgeon per year. For the continuous variables, we used Mann-Whitney and Student tests. We assessed survival analysis according to hilar control approach by Kaplan-Meier curves with log rank tests. A logistic regression multivariate analysis was used to evaluate the independent factors of PSM.
Outcomes of 224 off-clamp RPN for RCC were compared to 1135 on-clamp RPN. PSM rate was not statistically different, with 5.6% in the off-clamp group, and 11% in the on-clamp group (p = 0.1). When assessing survival analysis for overall survival (OS), local recurrence-free survival (LR), and metastasis-free survival (MFS) according to hilar clamping approach, there were no statistically significant differences between the two groups with p value log rank = 0.2, 0.8, 0.1, respectively. In multivariate analysis assessing SE, hilar control approach, hospital volume (HV), RENAL score, gender, Age, ECOG, EBL, BMI, and indication of NSS, age at surgery was associated with PSM (odds ratio [OR] 1.03 (95% CI 1.00-1.04), 0.02), whereas SE, HV, and type of hilar control approach were not predictive factors of PSM.
Hilar control approach seems to have no impact on PSM of RPN for RCC. Our findings were consistent with randomized trials.
比较无阻断与有阻断机器人辅助肾部分切除术（RPN）治疗肾细胞癌（RCC）的肿瘤学结局，并评估手术经验（SE）的影响。
我们从法国国家肾癌研究网络（UROCCR）前瞻性维护的数据库中提取了1359例当代队列患者的数据。主要目标是评估手术切缘阳性（PSM）率。我们还将患者分为三组手术经验（SE）作为次要终点，评估了无论手术经验如何的肿瘤学结局。SE由每位外科医生每年的RPN病例数定义。对于连续变量，我们使用了曼-惠特尼检验和学生检验。我们通过带有对数秩检验的Kaplan-Meier曲线根据肾门控制方法评估生存分析。采用逻辑回归多变量分析来评估PSM的独立因素。
将224例无阻断RPN治疗RCC的结局与1135例有阻断RPN进行比较。PSM率无统计学差异，无阻断组为5.6%，有阻断组为11%（p = 0.1）。根据肾门阻断方法评估总生存期（OS）、无局部复发生存期（LR）和无转移生存期（MFS）的生存分析时，两组之间无统计学显著差异，p值对数秩分别为0.2、0.8、0.1。在评估SE、肾门控制方法、医院容量（HV）、RENAL评分、性别、年龄、ECOG、术中出血量（EBL）、体重指数（BMI）和保肾手术指征的多变量分析中，手术年龄与PSM相关（优势比[OR] 1.03（95% CI 1.00 - 1.04），p = 0.02），而SE、HV和肾门控制方法类型不是PSM的预测因素。
肾门控制方法似乎对RPN治疗RCC的PSM无影响。我们的发现与随机试验一致。
