Service d'urologie, Urology Department, Bordeaux University Hospital, CHU de Bordeaux, Place Amelie Raba Leon, 33000, Bordeaux, France.
Urology Department, Henri Mondor University Hospital, APHP, Paris, France.
World J Urol. 2023 Aug;41(8):2281-2288. doi: 10.1007/s00345-023-04491-z. Epub 2023 Jul 6.
To describe the practice of robotic-assisted partial nephrectomy (RAPN) in France and prospectively assess the late complications and long-term outcomes.
Prospective, multicenter (n = 16), observational study including all patients diagnosed with a renal tumor who underwent RAPN. Preoperative, intraoperative, postoperative, and follow-up data were collected and stored in the French research network for kidney cancer database (UroCCR). Patients were included over a period of 12 months, then followed for 5 years.
In total, 466 patients were included, representing 472 RAPN. The mean tumor size was 3.4 ± 1.7 cm, most of moderate complexity (median PADUA and RENAL scores of 8 [7-10] and 7 [5-9]). Indication for nephron-sparing surgery was relative in 7.1% of cases and imperative in 11.8%. Intraoperative complications occurred in 6.8% of patients and 4.2% of RAPN had to be converted to open surgery. Severe postoperative complications were experienced in 2.3% of patients and late complications in 48 patients (10.3%), mostly within the first 3 months and mainly comprising vascular, infectious, or parietal complications. At 5 years, 29 patients (6.2%) had chronic kidney disease upstaging, 21 (4.5%) were diagnosed with local recurrence, eight (1.7%) with contralateral recurrence, 25 (5.4%) with metastatic progression, and 10 (2.1%) died of the disease.
Our results reflect the contemporary practice of French expert centers and is, to our knowledge, the first to provide prospective data on late complications associated with RAPN. We have shown that RAPN provides good functional and oncologic outcomes while limiting short- and long-term morbidity.
NCT03292549.
描述法国机器人辅助部分肾切除术（RAPN）的实践，并前瞻性评估晚期并发症和长期结果。
这是一项前瞻性、多中心（n=16）观察性研究，纳入所有诊断为肾肿瘤并接受 RAPN 的患者。收集并存储了术前、术中、术后和随访数据，并存储在法国肾癌研究网络数据库（UroCCR）中。患者在 12 个月的时间内被纳入研究，然后随访 5 年。
共纳入 466 例患者，共进行 472 例 RAPN。肿瘤平均大小为 3.4±1.7cm，大多数为中度复杂性（中位 PADUA 和 RENAL 评分分别为 8[7-10]和 7[5-9]）。保肾手术的适应证为相对适应证（7.1%）和绝对适应证（11.8%）。术中并发症发生率为 6.8%，4.2%的 RAPN 需要转为开放手术。术后严重并发症发生率为 2.3%，48 例（10.3%）发生晚期并发症，主要发生在术后 3 个月内，主要为血管、感染或壁层并发症。5 年时，29 例（6.2%）患者慢性肾脏病分期升级，21 例（4.5%）患者诊断为局部复发，8 例（1.7%）患者对侧复发，25 例（5.4%）患者转移进展，10 例（2.1%）患者死于疾病。
我们的研究结果反映了法国专家中心的当代实践，据我们所知，这是首次提供与 RAPN 相关的晚期并发症的前瞻性数据。我们已经表明，RAPN 提供了良好的功能和肿瘤学结果，同时限制了短期和长期的发病率。
NCT03292549。
