Pirzada Faisal Masood, Sood Rajeev, Taneja Anil, Sharma Umesh, Goel Hemant Kumar, Gahlawat Sumit
Department of Urology and Renal Transplant, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Department of Radiology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India.
Indian J Urol. 2023 Jul-Sep;39(3):216-222. doi: 10.4103/iju.iju_384_22. Epub 2023 Jun 30.
The number of renal tumors amenable to laparoscopic surgery is rising, both, due early detection by improved imaging techniques and due to progressive improvements in minimal access surgery. Conversion to open surgery, which is a significant event, can be minimized by proper case selection. We assessed the pre-operative factors that can predict the operative difficulty and can help in case selection, thus avoiding complications and reducing the chances of conversion to open.
One hundred and sixteen patients (73 males and 43 females) with the mean age of 50.78 ± 14.2 years, meeting the inclusion criteria underwent transperitoneal laparoscopic partial nephrectomy (LPN). Various clinical, anthropometric, radiological, and pathological parameters were recorded. Intraoperative difficulty was assessed and graded on a scale of 1 (easiest) to 4 (most difficult or open conversion) by an independent observer to calculate the difficulty score, which along with the other parameters of operative difficulty, was used to calculate the difficulty scale. Significant parameters on the univariate analysis, were subjected to a multivariate analysis, to find parameters that can predict the operative difficulty.
The mean age was 52 ± 14.29 years, mean size was 4 ± 1.04 cm, male:female ratio was 1.6:1, most of the tumors were exophytic (60%) and anteriorly located (62%) and had a mean perinephric fat surface density (PnFSD) of 6446.026 ± 2244 surface density pixel units (SDPU). On the univariate analysis, age >60 years, Eastern Cooperative Oncology Group performance score >1, presence of perinephric fat stranding, increased PnFSD (>10,000 SDPU), large tumor size (>4 cm), hilar/posterior location, endophytic tumors and higher clinical stage were significantly associated with intraoperative difficulty. However, on the multivariate analysis, no single factor could independently predict intraoperative difficulty in LPN for Renal tumors.
It is difficult to predict the intra-operative difficulty during LPN. Feasibility of LPN should be based on multiple factors rather than a single factor.
由于成像技术的改进实现了早期检测，以及微创外科手术的不断进步，适合腹腔镜手术的肾肿瘤数量正在增加。转为开放手术是一个重大事件，通过适当的病例选择可以将其降至最低。我们评估了术前因素，这些因素可以预测手术难度并有助于病例选择，从而避免并发症并减少转为开放手术的几率。
116例（73例男性和43例女性）平均年龄为50.78±14.2岁且符合纳入标准的患者接受了经腹腹腔镜部分肾切除术（LPN）。记录了各种临床、人体测量、放射学和病理学参数。由一名独立观察者对术中难度进行评估并按1（最容易）至4（最困难或转为开放手术）的等级进行分级，以计算难度评分，该评分与手术难度的其他参数一起用于计算难度量表。对单因素分析中的显著参数进行多因素分析，以找出可预测手术难度的参数。
平均年龄为52±14.29岁，平均大小为4±1.04厘米，男女比例为1.6:1，大多数肿瘤为外生性（60%）且位于前部（62%），肾周脂肪表面密度（PnFSD）平均为6446.026±2244表面密度像素单位（SDPU）。单因素分析显示，年龄>60岁、东部肿瘤协作组体能状态评分>1、存在肾周脂肪条索、PnFSD增加（>10,000 SDPU）、肿瘤较大（>4厘米）、肾门/后部位置、内生性肿瘤和更高的临床分期与术中难度显著相关。然而，多因素分析显示，没有单一因素能够独立预测肾肿瘤LPN术中的难度。
LPN术中难度难以预测。LPN的可行性应基于多种因素而非单一因素。
