Regina Elena National Cancer Institute, Dept. of Urology, Via Elio Chianesi 53, 00144, Rome, Italy.
Regina Elena National Cancer Institute, Dept. of Urology, Via Elio Chianesi 53, 00144, Rome, Italy.
Eur J Surg Oncol. 2022 Aug;48(8):1848-1853. doi: 10.1016/j.ejso.2022.01.024. Epub 2022 Feb 3.
Purely hilar lesions and those abutting the main renal artery or vein may be significantly different in terms of surgical complexity, requiring different resection strategies. To describe surgical technique and to assess its safety, oncologic and functional outcomes of a single centre experience of Off-Clamp Robotic Partial Nephrectomy (Off-C RPN) for purely hilar renal masses.
The Institutional Review Board renal cancer database was queried for: "robotic", "partial nephrectomy" and "hilar". Baseline imaging was reviewed for all cases to strictly select patients with purely hilar tumors, defined as tumors arising into the renal hilum without any exophytic growth. Off-C RPN with straight access to the hilum was performed in all cases. We reported baseline, perioperative, oncologic and functional outcomes of the institutional series of purely hilar masses treated with Off-C RPN.
Between 2011 and 2019, 680 Off-C RPN were performed. Overall, 20 cases were classified as "hilar" renal tumors. Ten lesions abutting the main renal artery or vein were excluded leaving 10 purely hilar cases for analysis. Median operative time was 85 (range 68-115) minutes. No high-grade complications occurred. One patient (10%) required blood transfusion. At a median follow-up of 27 months, one renal recurrence and one newly onset Chronic Kidney Disease stage 3A was observed.
RPN for purely hilar tumors has been poorly addressed and distinguishing purely hilar from tumors abutting the hilar vessels may have significant technical implications. In tertiary referral centers, Off-C RPN for purely hilar tumors provides excellent perioperative, oncologic and functional outcomes.
单纯肾门部位的病变以及与主肾动静脉毗邻的病变在手术复杂性方面可能存在显著差异，需要采用不同的切除策略。本文旨在描述一种手术技术，并评估其安全性、肿瘤学和功能结果，探讨单中心采用无阻断机器人辅助部分肾切除术（Off-C RPN）治疗单纯肾门部位肿瘤的经验。
通过机构审查委员会的肾癌数据库，检索“机器人”“部分肾切除术”和“肾门”。对所有病例的基线影像学进行回顾性分析，以严格选择仅存在肾门部位肿瘤的患者，这些肿瘤完全位于肾门内，无任何外生性生长。所有病例均采用直线进入肾门的方式进行 Off-C RPN。我们报告了机构系列中单纯肾门部位肿瘤患者接受 Off-C RPN 治疗的基线、围手术期、肿瘤学和功能结果。
在 2011 年至 2019 年间，共进行了 680 例 Off-C RPN。总体而言，有 20 例病例被归类为“肾门”肿瘤。排除了 10 例与主肾动静脉毗邻的病变，留下 10 例单纯肾门部位病变进行分析。中位手术时间为 85 分钟（范围 68-115 分钟）。无高分级并发症发生。1 例患者（10%）需要输血。中位随访 27 个月时，观察到 1 例肾复发和 1 例新发慢性肾脏病 3A 期。
单纯肾门部位肿瘤的 RPN 处理方法尚不完善，区分单纯肾门部位与毗邻肾门血管的肿瘤可能具有重要的技术意义。在三级转诊中心，单纯肾门部位肿瘤的 Off-C RPN 可提供出色的围手术期、肿瘤学和功能结果。
