Department of Urology, Brussels University Hospital, Brussels, Belgium -
Department of Urology, CHU Bordeaux, Bordeaux, France.
Minerva Urol Nephrol. 2023 Aug;75(4):434-442. doi: 10.23736/S2724-6051.23.05346-6.
Robot-assisted partial nephrectomy can be performed through either a transperitoneal or retroperitoneal approach. This study aimed to compare the rate of trifecta achievement between retroperitoneal (RRPN) and transperitoneal (TRPN) robot-assisted partial nephrectomy using a large multicenter prospectively-maintained database and propensity-score matching analysis.
This study was launched by the French Kidney Cancer Research Network, under the UroCCR Project (NCT03293563). Patients who underwent TRPN or RRPN by experienced surgeons in 15 participating centers were included. Data on demographic and clinical parameters, tumor characteristics, renal function, and surgical parameters were collected. The primary outcome was the rate of trifecta achievement, which was defined as a warm ischemia time of less than 25 minutes, negative surgical margins, and no major complications. Secondary outcomes included operative time, hospital length-of-stay, blood loss, postoperative complications, postoperative renal function, and each trifecta item taken alone. Subgroup analysis was done according to tumor location.
A total of 2879 patients (2581 TRPN vs. 298 RRPN) were included in the study. Before matching, trifecta was achieved in 73.0% of the patients in the TRPN group compared to 77.5% in the RRPN group (P=0.094). After matching 157 patients who underwent TRPN to 157 patients who underwent RRPN, the trifecta rate was 82.8% in the TRPN group vs. 84.0% in the RRPN group (P=0.065). The RRPN group showed shorter operative time (123 vs. 171 min; P<0.001) and less blood loss (161 vs. 293 mL; P<0.001). RRPN showed a higher trifecta achievement for posterior tumors than TRPN (71% vs. 81%; P=0.017).
RRPN is a viable alternative to the transperitoneal approach, particularly for posterior renal tumors, and is a safe and effective option for partial nephrectomy.
机器人辅助部分肾切除术可以通过经腹腔或后腹腔途径进行。本研究旨在通过大型多中心前瞻性维护数据库和倾向评分匹配分析，比较后腹腔（RRPN）和经腹腔（TRPN）机器人辅助部分肾切除术的 trifecta 实现率。
该研究由法国肾癌研究网络在 UroCCR 项目（NCT03293563）下发起。纳入了 15 个参与中心经验丰富的外科医生进行 TRPN 或 RRPN 的患者。收集了人口统计学和临床参数、肿瘤特征、肾功能和手术参数的数据。主要结局是 trifecta 的实现率，定义为热缺血时间小于 25 分钟、无手术切缘阳性和无重大并发症。次要结局包括手术时间、住院时间、出血量、术后并发症、术后肾功能以及单独的 trifecta 项目。根据肿瘤位置进行了亚组分析。
共纳入 2879 例患者（2581 例 TRPN 与 298 例 RRPN）。在匹配前，TRPN 组 73.0%的患者实现 trifecta，RRPN 组为 77.5%（P=0.094）。匹配后，TRPN 组 157 例患者与 RRPN 组 157 例患者匹配，TRPN 组 trifecta 率为 82.8%，RRPN 组为 84.0%（P=0.065）。RRPN 组的手术时间更短（123 分钟比 171 分钟；P<0.001），出血量更少（161 毫升比 293 毫升；P<0.001）。RRPN 对后肾肿瘤的 trifecta 实现率高于 TRPN（71%比 81%；P=0.017）。
RRPN 是经腹腔入路的可行替代方法，特别是对于后肾肿瘤，是一种安全有效的部分肾切除术选择。
