1Department of Urology, Clinical City Hospital Cluj-Napoca, Romania.
J BUON. 2021 May-Jun;26(3):1088-1093.
To evaluate the safety of 3D laparoscopic off clamp simple enucleation (SE) of kidney tumors versus standard laparoscopic on-clamp partial nephrectomy (PN) in terms of perioperative, oncological and functional outcomes.
All patients that underwent 3D laparoscopic nephron sparing surgery (NSS) in our department for clinical T1 tumors between January 2019-September 2020 were included. Of the total of 84 patients, 38 (45.24%) underwent SE (SE group) and 46 (54.76%) PN (PN group). Perioperative data was collected and analyzed. Oncological outcomes were evaluated by the positive surgical margin (PSM) rate and follow-up at 6 months after surgery.
Mean age, gender, tumor size, PADUA score and length of hospital stay were comparable between the two groups. Estimated intraoperative blood loss (284.21 ml vs 151.52 ml, p=0.0001) and hemoglobin drop (p=0.0001) were significantly lower for the PN group. Patients that underwent SE showed a better preservation of renal function (eGFR drop of 4.4 ml/min vs 1.78 ml/min, p=0.75). No significant differences were found regarding the PSM, although the PSM rate was lower in the SE group when compared with the PN group (2.63% vs 4.34%, p= 0.07).
Off-clamp simple enucleation of renal masses is feasible by laparoscopic approach and has produced comparable oncologic outcomes with standard on-clamp partial nephrectomy, with an incremental advantage for the preservation of renal function.
评估 3D 腹腔镜无夹闭肾肿瘤单纯剜除术（SE）与标准腹腔镜夹闭部分肾切除术（PN）在围手术期、肿瘤学和功能结果方面的安全性。
纳入 2019 年 1 月至 2020 年 9 月期间在我科行 3D 腹腔镜肾部分切除术（NSS）治疗临床 T1 肿瘤的所有患者。在总共 84 例患者中，38 例（45.24%）接受 SE（SE 组），46 例（54.76%）接受 PN（PN 组）。收集并分析围手术期数据。通过术后 6 个月的阳性切缘（PSM）率和随访来评估肿瘤学结果。
两组患者的平均年龄、性别、肿瘤大小、PADUA 评分和住院时间无差异。PN 组术中估计失血量（284.21ml 比 151.52ml，p=0.0001）和血红蛋白下降量（p=0.0001）明显低于 SE 组。SE 组患者的肾功能保存更好（eGFR 下降 4.4ml/min 比 1.78ml/min，p=0.75）。PSM 无显著差异，但 SE 组的 PSM 率低于 PN 组（2.63%比 4.34%，p=0.07）。
腹腔镜无夹闭单纯剜除肾肿瘤是可行的，其肿瘤学结果与标准夹闭部分肾切除术相当，在保留肾功能方面具有优势。
