Department of Urology, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, 6th Floor, New York, NY, 10029, USA.
J Robot Surg. 2023 Oct;17(5):2451-2460. doi: 10.1007/s11701-023-01664-1. Epub 2023 Jul 20.
Partial nephrectomy (PN) is an alternative to radical nephrectomy (RN) in the appropriate localized renal tumor. The scope of PN has expanded over time and, since the advent and proliferation of minimally invasive surgery, more surgeons have access to and have been trained in laparoscopic and robotic technology. Amid the changing surgical landscape, we sought to characterize the trends in management by cancer stage, institution type, and geographic location using the National Cancer Database (NCDB). We queried the NCDB for patients with kidney cancer from 2004 to 2019. Overall, 241,311 patients who underwent PN or RN were included in the study. The nephrectomy approach was categorized as robotic partial (RPN), robotic radical (RRN), laparoscopic partial (LPN), laparoscopic radical (LRN), open or unspecified partial (OPN), and open or unspecified radical (ORN). The categorical variables were presented as frequency and percentages. Overall, there was an increase in the utilization of robotic approaches from 2010 to 2019. For cT1 tumors, the use of RPN and RRN increased from 14.27 to 33.06% and 5.24% to 19.63%, respectively. The use of ORN for cT2 and cT3 tumors declined, with rates dropping from 54.71 to 10.76% and 64.71 to 46.64%, respectively. Conversely, the utilization of RRN rose during this period. However, ORN remained the most common approach for cT3 tumors. The use of RPN increased across different facility types, with the highest utilization observed in academic/research programs. The use of ORN for cT2 and cT3 tumors declined across facility types, although it remained most prevalent in community cancer programs. The use of robot-assisted surgery to treat localized renal cancer increased in the US between 2010 and 2019 across all stages of disease. RPN became the most used approach for cT1 disease, while LRN was preferred for cT2 disease. ORN remained the approach of choice for cT3 disease throughout the study period. Trends in facility type and geographic location largely mirrored the overall trends.
部分肾切除术 (PN) 是治疗适当局限性肾肿瘤的根治性肾切除术 (RN) 的替代方法。随着时间的推移，PN 的范围不断扩大，并且由于微创外科的出现和普及，越来越多的外科医生可以使用并接受过腹腔镜和机器人技术的培训。在不断变化的手术环境中，我们利用国家癌症数据库 (NCDB) 来描述按癌症分期、机构类型和地理位置进行管理的趋势。我们从 2004 年至 2019 年对 NCDB 中的肾癌患者进行了查询。共有 241311 例接受 PN 或 RN 的患者纳入研究。肾切除术方法分为机器人部分切除术 (RPN)、机器人根治性切除术 (RRN)、腹腔镜部分切除术 (LPN)、腹腔镜根治性切除术 (LRN)、开放性或未特指部分切除术 (OPN) 和开放性或未特指根治性切除术 (ORN)。分类变量以频率和百分比表示。总体而言，2010 年至 2019 年，机器人方法的使用率有所增加。对于 cT1 肿瘤，RPN 和 RRN 的使用率分别从 14.27%增加到 33.06%和从 5.24%增加到 19.63%。cT2 和 cT3 肿瘤的 ORN 使用率下降，比率从 54.71%下降到 10.76%和从 64.71%下降到 46.64%。相反，在此期间 RRN 的使用率有所上升。然而，ORN 仍然是 cT3 肿瘤最常见的方法。不同类型的医疗机构都增加了 RPN 的使用，在学术/研究项目中使用率最高。尽管在社区癌症项目中，ORN 仍然是最常见的治疗方法，但 cT2 和 cT3 肿瘤的 ORN 使用率在各种医疗机构中均有所下降。2010 年至 2019 年，美国所有疾病阶段的机器人辅助手术治疗局限性肾癌的使用率均有所增加。RPN 成为 cT1 疾病最常用的方法，而 LRN 则是 cT2 疾病的首选方法。ORN 仍然是整个研究期间 cT3 疾病的首选方法。机构类型和地理位置的趋势在很大程度上反映了总体趋势。
