机器人辅助与传统开放部分肾切除术（Robocop）：249 例患者的倾向评分匹配分析。

Robotic-Assisted Versus Conventional Open Partial Nephrectomy (Robocop): A Propensity Score-Matched Analysis of 249 Patients.

机构信息

Department of Urology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany,

Department of Urology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.

出版信息

Urol Int. 2021;105(5-6):490-498. doi: 10.1159/000513189. Epub 2021 Mar 11.

DOI:10.1159/000513189

PMID:33706322

Abstract

OBJECTIVES

The objective of this study was to compare open partial nephrectomy (OPN) and robotic-assisted PN (RAPN) based on a propensity score-matched sample and to test the Comprehensive Complication Index (CCI) as an end point for complications.

METHODS

Patients undergoing PN from 2010 to 2018 at a university care center were included. OPN and RAPN cases were matched in a 2:1 ratio using propensity score-matching with age, gender, BMI, RENAL score, and tumor size as confounders. The primary end point was complications measured with the CCI as continuous score (0-100, 100 indicating death).

RESULTS

Data of 570 patients were available. After matching, both cohorts (OPN = 166; RAPN = 83) showed no baseline differences. For the primary end point, CCI, RAPN was superior (RAPN 2.6 ± 7.9 vs. OPN 8.7 ± 13.9; p < 0.001). Additionally, RAPN was superior for length of stay (RAPN 6.5 ± 4.0 vs. OPN 7.4 ± 3.5 days; p < 0.001), hemoglobin drop (RAPN 2.8 ± 1.4 vs. OPN 3.8 ± 1.6 g/dL; p < 0.001), and drop of glomerular filtration rate (RAPN 11.4 ± 14.2 vs. OPN 19.5 ± 14.3 mL/min; p < 0.001). OPN had shorter operating times (RAPN 157 ± 43 vs. OPN 143 ± 45 min; p = 0.014) and less ischemia (RAPN 13% vs. OPN 28%; p = 0.016).

CONCLUSIONS

RAPN provides superior short-term results regarding overall complications without compromising renal function for small and less complex tumors. However, OPN remains an important option for more complex and larger tumors.

摘要

目的

本研究旨在通过倾向评分匹配样本比较开放部分肾切除术（OPN）和机器人辅助肾部分切除术（RAPN），并测试综合并发症指数（CCI）作为并发症的终点。

方法

纳入 2010 年至 2018 年在大学医疗中心接受 PN 的患者。使用倾向评分匹配，以年龄、性别、BMI、RENAL 评分和肿瘤大小为混杂因素，将 OPN 和 RAPN 病例以 2:1 的比例匹配。主要终点是使用 CCI 作为连续评分（0-100，100 表示死亡）测量的并发症。

结果

共 570 例患者的数据可用。匹配后，两组（OPN = 166；RAPN = 83）均无基线差异。对于主要终点，CCI，RAPN 更优（RAPN 2.6±7.9 比 OPN 8.7±13.9；p<0.001）。此外，RAPN 在住院时间（RAPN 6.5±4.0 比 OPN 7.4±3.5 天；p<0.001）、血红蛋白下降（RAPN 2.8±1.4 比 OPN 3.8±1.6 g/dL；p<0.001）和肾小球滤过率下降（RAPN 11.4±14.2 比 OPN 19.5±14.3 mL/min；p<0.001）方面也更优。OPN 手术时间更短（RAPN 157±43 比 OPN 143±45 min；p=0.014）且缺血时间更短（RAPN 13%比 OPN 28%；p=0.016）。