Department of Urologic Oncology, Medanta The Medicity, Gurgaon, India.
Faculty of Life Sciences and Medicine, King's College, King's Health Partners, London, UK.
J Robot Surg. 2023 Oct;17(5):2141-2147. doi: 10.1007/s11701-023-01627-6. Epub 2023 May 30.
To compare perioperative outcomes following robot-assisted partial nephrectomy (RAPN) in patients with morbid obesity (body mass index (BMI > 40 kg/m)) and non-obese patients. Using the Vattikuti Collective quality initiative (VCQI) database for RAPN, data for morbidly obese and non-obese patients was obtained. Propensity scores were calculated for two treatment groups (morbidly obese vs. non-obese) for the following variables i.e. age, sex, tumor size, RNS, surgical access (retroperitoneal/transperitoneal) and estimated glomerular filtration rate (eGFR) to ensure comparability. The primary outcome for the study was comparison of trifecta between the two groups. In this study, 158 morbidly obese patients were matched with 158 non-obese patients undergoing RAPN. Two groups matched well for age, sex, tumor size, eGFR and RNS. There was no difference between two groups for ischemia time, blood loss, blood transfusion, conversion to radical nephrectomy, length of stay, intraoperative and postoperative complications. Operative time was longer in morbidly obese patients (median 210 min vs. 120 min, p = 0.000). On pathological analysis, malignant tumors were more likely in the morbidly obese group (83.1% vs.73.4%, p = 0.018). Trifecta outcomes were comparable between the two groups (60.1% vs. 63.3%, p = 0.563). The Median duration of follow-up was 12 months (1-96 months). The morbidly obese group had significantly higher day one creatinine (1.25 ± 0.7 vs. 1.07 ± 0.37, p = 0.001) and significantly lower day one eGFR (62.1 ± 19 vs. 69.2 ± 21, p = 0.018). However, there was no difference between the two groups for the last follow-up creatinine and eGFR. RAPN in morbidly obese patients is associated with equivalent perioperative outcomes compared to non-obese patients.
比较肥胖患者（体重指数（BMI>40kg/m2）和非肥胖患者接受机器人辅助部分肾切除术（RAPN）的围手术期结果。使用 Vattikuti 集体质量倡议（VCQI）数据库进行 RAPN，获得了肥胖患者和非肥胖患者的数据。为了确保可比性，为两个治疗组（肥胖与非肥胖）计算了以下变量的倾向评分：年龄、性别、肿瘤大小、RNS、手术途径（腹膜后/经腹腔）和估计肾小球滤过率（eGFR）。本研究的主要结果是比较两组的 trifecta。在这项研究中，158 名肥胖患者与 158 名接受 RAPN 的非肥胖患者相匹配。两组在年龄、性别、肿瘤大小、eGFR 和 RNS 方面匹配良好。两组在缺血时间、失血量、输血、转为根治性肾切除术、住院时间、术中及术后并发症方面无差异。肥胖患者的手术时间较长（中位数 210 分钟 vs. 120 分钟，p=0.000）。在病理分析中，肥胖组恶性肿瘤更常见（83.1% vs. 73.4%，p=0.018）。两组 trifecta 结果相当（60.1% vs. 63.3%，p=0.563）。中位随访时间为 12 个月（1-96 个月）。肥胖组第 1 天肌酐明显升高（1.25±0.7 vs. 1.07±0.37，p=0.001），第 1 天 eGFR 明显降低（62.1±19 vs. 69.2±21，p=0.018）。然而，两组在最后一次随访时的肌酐和 eGFR 无差异。肥胖患者接受 RAPN 与非肥胖患者相比，围手术期结果相当。
