Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, 6th Floor, New York City, NY, 10029, USA.
Department of Urology, OhioHealth Dublin Methodist Hospital, Dublin, OH, USA.
J Robot Surg. 2023 Aug;17(4):1579-1585. doi: 10.1007/s11701-023-01538-6. Epub 2023 Mar 16.
We aim to describe the perioperative and oncological outcomes for salvage robotic partial nephrectomy (sRPN) and salvage robotic radical nephrectomy (sRRN). Using a prospectively maintained multi-institutional database, we compared baseline clinical characteristics and perioperative and postoperative outcomes, including pathological stage, tumor histology, operative time, ischemia time, estimated blood loss (EBL), length of stay (LOS), postoperative complication rate, recurrence rate, and mortality. We identified a total of 58 patients who had undergone robotic salvage surgery for a recurrent renal mass, of which 22 (38%) had sRRN and 36 (62%) had sRPN. Ischemia time for sRPN was 14 min. The median EBL was 100 mL in both groups (p = 0.581). One intraoperative complication occurred during sRRN, while three occurred during sRPN cases (p = 1.000). The median LOS was 2 days for sRRN and 1 day for sRPN (p = 0.039). Postoperatively, one major complication occurred after sRRN and two after sRPN (p = 1.000). The recurrence reported after sRRN was 5% and 3% after sRPN. Among the patients who underwent sRRN, the two most prevalent stages were pT1a (27%) and pT3a (27%). Similarly, the two most prevalent stages in sRPN patients were pT1a (69%) and pT3a (6%). sRRN and sRPN have similar operative and perioperative outcomes. sRPN is a safe and feasible procedure when performed by experienced surgeons. Future studies on large cohorts are essential to better characterize the importance and benefit of salvage partial nephrectomies.
我们旨在描述挽救性机器人部分肾切除术(sRPN)和挽救性机器人根治性肾切除术(sRRN)的围手术期和肿瘤学结果。使用前瞻性维护的多机构数据库,我们比较了基线临床特征和围手术期及术后结果,包括病理分期、肿瘤组织学、手术时间、缺血时间、估计失血量(EBL)、住院时间(LOS)、术后并发症发生率、复发率和死亡率。我们共确定了 58 例因复发性肾肿块而行机器人挽救性手术的患者,其中 22 例(38%)行 sRRN,36 例(62%)行 sRPN。sRPN 的缺血时间为 14 分钟。两组的中位 EBL 均为 100ml(p=0.581)。sRRN 术中发生 1 例并发症,sRPN 术中发生 3 例(p=1.000)。sRRN 的中位 LOS 为 2 天,sRPN 为 1 天(p=0.039)。术后,sRRN 后发生 1 例严重并发症,sRPN 后发生 2 例(p=1.000)。sRRN 报告的复发率为 5%,sRPN 为 3%。在接受 sRRN 的患者中,最常见的两个分期为 pT1a(27%)和 pT3a(27%)。同样,sRPN 患者中最常见的两个分期为 pT1a(69%)和 pT3a(6%)。sRRN 和 sRPN 的手术和围手术期结果相似。当由经验丰富的外科医生进行操作时,sRPN 是一种安全可行的手术。未来需要对大样本队列进行研究,以更好地描述挽救性部分肾切除术的重要性和益处。