腹腔镜肾部分切除术和根治性肾切除术治疗 cT1 期肾肿瘤。并发症和生存的比较分析。
Laparoscopic nephron sparing surgery and radical nephrectomy in cT1 renal tumors. Comparative analysis of complications and survival.
机构信息
Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Hospital General Universitario Gregorio Marañón, Madrid, Spain.
出版信息
Actas Urol Esp (Engl Ed). 2022 Jul-Aug;46(6):340-347. doi: 10.1016/j.acuroe.2021.11.005. Epub 2022 May 28.
INTRODUCTION AND OBJECTIVES
Comparative analysis of postoperative complications and survival between laparoscopic partial nephrectomy (PN) and radical nephrectomy (RN) in cT1 renal cell carcinoma (RCC).
MATERIAL AND METHOD
Retrospective study of patients with two kidneys and single renal tumor cT1 treated in our center between 2005 and 2018 by laparoscopic PN or RN.
RESULTS
372 patients met the inclusion criteria for the study. RN was performed in 156 (41.9%) patients and PN in 216 (58.1%). Clavien Dindo III-V complications were observed in 10 (4,6%) PN and 6 (3,9%) RN patients (p = 0.75). The comorbidity Charlson index (CCI) was identified as an independent predictor variable of complications (p = 0.02) and surgical approach did not affect multivariate analysis. Estimated overall survival (OS) was 81.2% and 56.8% at 5 and 10 years in the RN group and 90.2% and 75.7% in the PN group, respectively (p = 0.0001). Obesity (HR 2.77, p = 0.01), CCI ≥ 3 (HR 3.69, p = 0.001) and glomerular filtration rate (GFR) <60 mL/min/1.73 m at discharge (HR 1.87, p = 0.03) were identified as predictors of overall mortality. Nephrectomy approach showed no influence on OS. Estimated recurrence-free survival (RFS) was 86.1% at 5 and 10 years in the RN group and 93.5% and 83.6% in the PN group, respectively (p = 0.22).
CONCLUSIONS
Laparoscopic PN is not inferior to RN in terms of oncologic and surgical safety in cT1 RCC. Nephrectomy approach did not influence patient OS, however, obesity, CCI ≥ 3 and GFR <60 mL/min/1.73 m at discharge did behave as predictors.
介绍和目的
比较腹腔镜部分肾切除术（PN）和根治性肾切除术（RN）治疗 cT1 肾细胞癌（RCC）术后并发症和生存的差异。
材料和方法
回顾性分析 2005 年至 2018 年在我们中心接受腹腔镜 PN 或 RN 治疗的双侧肾脏和单发肾肿瘤 cT1 患者。
结果
372 例患者符合研究纳入标准。156 例（41.9%）患者行 RN，216 例（58.1%）患者行 PN。PN 组中有 10 例（4.6%）和 RN 组中有 6 例（3.9%）患者发生 Clavien Dindo III-V 级并发症（p=0.75）。合并症 Charlson 指数（CCI）被确定为并发症的独立预测变量（p=0.02），而手术方式在多变量分析中没有影响。RN 组患者的总体生存率（OS）分别为 5 年和 10 年的 81.2%和 56.8%，PN 组分别为 90.2%和 75.7%（p=0.0001）。肥胖（HR 2.77，p=0.01）、CCI≥3（HR 3.69，p=0.001）和出院时肾小球滤过率（GFR）<60 mL/min/1.73 m（HR 1.87，p=0.03）被确定为总体死亡率的预测因素。肾切除术方式对 OS 没有影响。RN 组患者的无复发生存率（RFS）分别为 5 年和 10 年的 86.1%和 74.0%，PN 组患者的 RFS 分别为 93.5%和 83.6%（p=0.22）。
结论
在 cT1 RCC 中，腹腔镜 PN 在肿瘤学和手术安全性方面并不逊于 RN。肾切除术方式并未影响患者的 OS，但肥胖、CCI≥3 和出院时 GFR<60 mL/min/1.73 m 是死亡率的预测因素。
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