Amparore Daniele, Pecoraro Angela, Piramide Federico, Verri Paolo, Checcucci Enrico, De Cillis Sabrina, Piana Alberto, Burgio Mariano, Di Dio Michele, Manfredi Matteo, Fiori Cristian, Porpiglia Francesco
Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy.
European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group, Arnhem, Netherlands.
Asian J Urol. 2022 Jul;9(3):263-271. doi: 10.1016/j.ajur.2022.06.003. Epub 2022 Jun 20.
The aim of the study was to evaluate three-dimensional virtual models (3DVMs) usefulness in the intraoperative assistance of minimally-invasive partial nephrectomy in highly complex renal tumors.
At our institution cT1-2N0M0 all renal masses with Preoperative Aspects and Dimensions Used for an Anatomical classification score ≥10 treated with minimally-invasive partial nephrectomy were considered for the present study. For inclusion a baseline contrast-enhanced computed tomography in order to obtain 3DVMs, the baseline and postoperative serum creatinine as well as estimated glomerular filtration rate values were needed. These patients, in which 3DVMs were used to assist the surgeon in the planning and intraoperative guidance, were then compared with a control group of patients who underwent minimally-invasive partial nephrectomy with the same renal function assessments, but without 3DVMs. Multivariable logistic regression models were used to predict the margin, ischemia, and complication score achievement.
Overall, 79 patients met the inclusion criteria and were compared with 143 complex renal masses without 3DVM assistance. The 3DVM group showed better postoperative outcomes in terms of baseline-weighted differential estimated glomerular filtration rate (-17.7% -22.2%, =0.03), postoperative complications (16.5% 23.1%, =0.03), and major complications (Clavien Dindo >III, 2.5% 5.6%, =0.03). At multivariable logistic regression 3DVM assistance independently predicted higher rates of successful partial nephrectomy (odds ratio: 1.42, =0.03).
3DVMs represent a useful tool to plan a tailored surgical approach in case of surgically complex masses. They can be used in different ways, matching the surgeon's needs from the planning phase to the demolitive and reconstructive phase, leading towards maximum safety and efficacy outcomes.
本研究旨在评估三维虚拟模型（3DVMs）在高度复杂肾肿瘤微创部分肾切除术中的术中辅助作用。
在本机构，所有cT1-2N0M0且术前解剖学分类评分≥10分并接受微创部分肾切除术的肾肿块均纳入本研究。纳入研究需要有用于获取3DVMs的基线对比增强计算机断层扫描、基线和术后血清肌酐以及估计肾小球滤过率值。将这些使用3DVMs辅助外科医生进行手术规划和术中指导的患者，与一组接受相同肾功能评估但未使用3DVMs的微创部分肾切除术患者进行比较。使用多变量逻辑回归模型预测切缘、缺血和并发症评分的达成情况。
总体而言，79例患者符合纳入标准，并与143例未使用3DVMs辅助的复杂肾肿块患者进行比较。3DVM组在基线加权差异估计肾小球滤过率（-17.7% -22.2%，P = 0.03）、术后并发症（16.5% 23.1%，P = 0.03）和主要并发症（Clavien Dindo>III级，2.5% 5.6%，P = 0.03）方面显示出更好的术后结果。在多变量逻辑回归分析中，3DVM辅助独立预测更高的部分肾切除成功率（优势比：1.42，P = 0.03）。
3DVMs是在手术复杂肿块情况下规划定制手术方法的有用工具。它们可以以不同方式使用，从规划阶段到切除和重建阶段满足外科医生的需求，从而实现最大的安全性和疗效结果。
