Department of Urology, Loyola University Medical Center, Maywood, IL.
Department of Urology, Loyola University Medical Center, Maywood, IL.
Urol Oncol. 2022 Oct;40(10):456.e1-456.e7. doi: 10.1016/j.urolonc.2022.05.015. Epub 2022 Jun 4.
We evaluated perioperative and mortality outcomes of robotic-assisted radical nephrectomy (RRN) vs. open radical nephrectomy (ORN) for very large renal cell carcinomas (RCC).
Adult patients with non-metastatic RCC >10 cm in size (pT2b) were identified from the National Cancer Database (2010-2017). Mixed-effects multivariable logistic regression adjusting for patient, tumor, and facility characteristics were used to evaluate rates of positive margin, prolonged length of stay (LOS) (>75th percentile), 30-day readmission, and 30-day and 90-day mortality for RRN vs. ORN. Overall survival (OS) was evaluated using the Kaplan-Meier method and adjusted Cox proportional hazard modeling.
Of the 2,977 patients who underwent radical nephrectomy, 492 (16.5%) underwent RRN. Factors associated with RRN included male gender, metro or urban locations, academic facilities, Charlson-Deyo score >2, private or Medicaid insurance, and surgery in a later year (all P < 0.05). Tumors ≥15.1cm in size were associated with a higher rate of conversion to open surgery (P < 0.001). ORN was associated with increased median postoperative LOS (4d [interquartile range; IQR 3-6] vs. 3d, [IQR 2-4]; P < 0.01). RRN demonstrated no significant difference in the risk of positive margin, 30-day readmission, 30-day mortality, or 90-day mortality. RRN was associated with a decreased risk of prolonged LOS (OR 0.38; 95%CI [0.28-0.53]). There was no difference in long-term OS observed in patients treated with ORN vs. RRN.
Very large, non-metastatic RCC can be safely and effectively treated with RRN. Rates of conversion to open were higher for tumors ≥15.1 cm. RRN has comparable long-term OS and improved LOS compared to ORN.
我们评估了机器人辅助根治性肾切除术（RRN）与开放性根治性肾切除术（ORN）治疗非常大的肾细胞癌（RCC）的围手术期和死亡率结果。
从国家癌症数据库（2010-2017 年）中确定了非转移性大小>10cm（pT2b）的 RCC 成年患者。使用混合效应多变量逻辑回归调整患者、肿瘤和设施特征，评估 RRN 与 ORN 之间的切缘阳性率、延长住院时间（LOS）（>75 百分位数）、30 天再入院率、30 天和 90 天死亡率。使用 Kaplan-Meier 方法评估总生存（OS），并使用调整后的 Cox 比例风险模型进行调整。
在 2977 例接受根治性肾切除术的患者中，492 例（16.5%）接受了 RRN。与 RRN 相关的因素包括男性、大都市或城市地区、学术设施、Charlson-Deyo 评分>2、私人或医疗补助保险以及手术时间较晚（均 P<0.05）。肿瘤大小≥15.1cm 与开放手术转化率较高相关（P<0.001）。ORN 与术后 LOS 中位数增加相关（4d [四分位距；IQR 3-6] vs. 3d，[IQR 2-4]；P<0.01）。RRN 在切缘阳性率、30 天再入院率、30 天死亡率或 90 天死亡率方面没有显著差异。RRN 与延长 LOS 的风险降低相关（OR 0.38；95%CI [0.28-0.53]）。接受 ORN 与 RRN 治疗的患者在长期 OS 方面没有差异。
非常大的、非转移性 RCC 可以安全有效地用 RRN 治疗。肿瘤大小≥15.1cm 的患者转化为开放手术的比例较高。与 ORN 相比，RRN 具有相似的长期 OS 和改善的 LOS。
