Liu Junyao, Zheng Duo, Qi Peng, Zheng Xu, Zhang Bin, He Yang, Wang Hongbo, Yue Zhongjin, Wang Zhiping, Shang Panfeng
Department of Urology, Lanzhou University Second Hospital, Lanzhou, China.
Front Surg. 2023 Feb 16;10:1114065. doi: 10.3389/fsurg.2023.1114065. eCollection 2023.
To figure out the difference of integrity of Gerota's fascia and perirenal fat between Retroperitoneal Laparoscopic Radical Nephrectomy (RLRN) and Transperitoneal Laparoscopic Radical Nephrectomy (TLRN).
This is a prospective comparative study of patients with Renal Cell Carcinoma (RCC) from a designated tertiary center in Lanzhou, China. We have developed and propose a scoring tool to quantify the integrity of nephrectomy specimens from both approaches. The integrity score is based on 6 common conditions of nephrectomy specimens. Specimens are scored on a 1 to 6-point scale according to the integrity of Gerota's fascia and perirenal fat. We applied the integrity score to 142 consecutive patients. Integrity scores were compared between RLRN and TLRN groups. Factors associated with low integrity score were assessed by logistic regression.
Among 142 patients, 79 (55.6%) patients and 63 (44.4%) patients, respectively, underwent RLRN and TLRN. There was a significant difference in the distribution of integrity score between the two groups ( < 0.001). RLRN (odds ratio 10.65, 95%CI 4.29-26.45, < 0.001), tumor size (odds ratio 1.22, 95%CI 1.04-1.42, = 0.015) and Body Mass Index (BMI) (odds ratio 0.83, 95%CI 0.72-0.96, = 0.010) were significantly associated with low integrity score. The logistic regression equation showed good power to predict low integrity score.
RLRN has poor integrity of Gerota's fascia and the perirenal fat. The integrity score can be used to evaluate the extent of resection and specimen completeness in LRN. Postoperative evaluation of the integrity score is of great value for urologists to evaluate the risk of tumor residue.
明确后腹腔镜根治性肾切除术（RLRN）与经腹腔腹腔镜根治性肾切除术（TLRN）之间肾周筋膜和肾周脂肪完整性的差异。
这是一项来自中国兰州某指定三级中心的肾细胞癌（RCC）患者的前瞻性对照研究。我们开发并提出了一种评分工具，用于量化两种手术方式下肾切除标本的完整性。完整性评分基于肾切除标本的6种常见情况。根据肾周筋膜和肾周脂肪的完整性，标本按1至6分进行评分。我们将完整性评分应用于142例连续患者。比较RLRN组和TLRN组的完整性评分。通过逻辑回归评估与低完整性评分相关的因素。
142例患者中，分别有79例（55.6%）和63例（44.4%）接受了RLRN和TLRN。两组完整性评分分布存在显著差异（<0.001）。RLRN（比值比10.65，95%可信区间4.29 - 26.45，<0.001）、肿瘤大小（比值比1.22，95%可信区间1.04 - 1.42，=0.015）和体重指数（BMI）（比值比0.83，95%可信区间0.72 - 0.96，=0.010）与低完整性评分显著相关。逻辑回归方程显示出良好的预测低完整性评分的能力。
RLRN的肾周筋膜和肾周脂肪完整性较差。完整性评分可用于评估腹腔镜肾切除术的切除范围和标本完整性。术后对完整性评分的评估对泌尿外科医生评估肿瘤残留风险具有重要价值。
