Department of Urology, The First Affiliated Hospital, Zhengzhou University, 1 Jian-She Road, Zhengzhou, 450052, Henan, China.
Department of Pharmacy, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan, China.
Surg Endosc. 2023 Jan;37(1):391-401. doi: 10.1007/s00464-022-09460-y. Epub 2022 Aug 18.
To compare the traditional single-layer and double-layer suture renorrhaphy with modified "Binding" suture renorrhaphy (whole rim of the wound was closed by the all-layer flow suture starting from the parenchyma cut edges to hilum, followed by the final defect closure) in robotic partial nephrectomy (RPN) for treating localized renal cell carcinoma in our large institutional experience.
We retrospectively reviewed clinical data of 406 consecutive patients who underwent RPN from May 2018 and December 2020 in our center. The demographic and oncologic outcome variables were compared between different renal reconstruction groups and the effect of these suture techniques on renal function outcomes was also evaluated.
For the single-layer group, median operative time and warm ischemic time were significantly less than that of the double-layer and "Binding" groups (p < 0.001), while the significantly lower eGFR drop (p = 0.014) was also detected within postoperative 3 months from baseline, but this difference lost its statistical significance from 3th month to the last follow-up. The changes in postoperative creatinine values were clinically insignificant among the three groups. In a sub-analysis over 258 patients with moderate/high nephrometry score, those patients who underwent "Binding" suture had an undifferentiated warm ischemic time, estimated blood loss, and length of hospitalization stay with a decreased risk of Grade III complications (postoperative hemorrhage requiring intervention) and improved renal function recovery during the whole follow-up.
Single-layer suture renorrhaphy may be associated with better renal functional preservation and could prove to be reliable in patients with low-complexity tumor (RENAL score ≤ 6). Patients with moderate/high-complexity tumor (RENAL score ≥ 7) might represent a subgroup of patients having a functional benefit after "Binding" suture renorrhaphy even in the long-term period.
为了在机器人辅助部分肾切除术（RPN）中比较传统的单层和双层缝合修复与改良的“Binding”缝合修复（从实质切缘到肾门全层流缝合闭合整个伤口边缘，然后最后闭合缺损），我们在我们的大型机构经验中比较了这两种方法治疗局限性肾细胞癌的效果。
我们回顾性分析了 2018 年 5 月至 2020 年 12 月期间在我们中心接受 RPN 的 406 例连续患者的临床资料。比较了不同肾重建组之间的人口统计学和肿瘤学结果变量，还评估了这些缝合技术对肾功能结果的影响。
对于单层组，手术时间和热缺血时间明显短于双层组和“Binding”组（p<0.001），术后 3 个月内 eGFR 下降幅度也明显较低（p=0.014），但从术后 3 个月到最后一次随访时，这一差异失去了统计学意义。三组术后肌酐值的变化无临床意义。在对 258 例中/高肾肿瘤评分患者的亚分析中，接受“Binding”缝合的患者具有无差异的热缺血时间、估计失血量和住院时间，术后 III 级并发症（需要干预的术后出血）的风险降低，肾功能恢复改善。
单层缝合修复可能与更好的肾功能保存相关，对于低复杂性肿瘤（RENAL 评分≤6）的患者可能是可靠的。中/高复杂性肿瘤（RENAL 评分≥7）的患者可能代表了“Binding”缝合修复后具有功能获益的亚组患者，即使在长期随访中也是如此。
