Weinberg Aaron C, Wright Jason D, Whalen Michael J, Paulucci David J, Woldu Solomon L, Berger Stephanie A, Deibert Christopher M, Korets Ruslan, Hershman Dawn L, Neugut Alfred I, Badani Ketan K
Department of Urology, Columbia University College of Physicians and Surgeons, New York, New York.
Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York.
Urol Pract. 2016 Nov;3(6):430-436. doi: 10.1016/j.urpr.2015.10.001. Epub 2016 Jul 21.
The advent of robotics may promote the dissemination of partial nephrectomy, and allow patients to experience survival and functional benefits compared to radical nephrectomy. Therefore, we assessed the impact of hospital acquisition of a robotic surgery platform on the rate of partial nephrectomy recorded in a nationwide database.
We identified 53,364 patients with a diagnosis of localized renal cell carcinoma who underwent extirpative surgery from 2006 to 2012 using the Perspective database. Procedures were categorized based on extent of surgery (radical nephrectomy vs partial nephrectomy), approach (open, laparoscopic, robotic) and hospital ownership of a surgical robot. Changes in the proportion of partial nephrectomies performed over time and the effect of acquiring a surgical robot on the proportion of partial nephrectomies performed were assessed with multivariable logistic regression.
Overall 40,147 (75.2%) radical nephrectomies and 13,217 (24.8%) partial nephrectomies were performed between 2006 and 2012. The proportion of hospitals using a surgical robot for renal cancer surgery increased from 1.8% in the first quarter of 2006 to 47.7% by the end of 2012. Partial nephrectomy use ranged from 19.1% to 31.2%. More robotic hospitals performed partial nephrectomy than nonrobotic hospitals (29.6% vs 18.0%, p <0.001). After acquisition of a surgical robot the partial nephrectomy rate increased from 16.4% to 34.3% (p <0.001). Hospitals with a robot were more likely to use partial nephrectomy than radical nephrectomy (OR 1.464, CI 1.39-1.54, p <0.001).
While laparoscopic partial nephrectomy remains a challenging operation, this study demonstrates that hospital ownership of a surgical robot is associated with increased use of partial nephrectomy in the treatment of localized renal masses.
机器人技术的出现可能会促进部分肾切除术的普及，并使患者相较于根治性肾切除术在生存和功能方面受益。因此，我们评估了医院购置机器人手术平台对全国数据库中记录的部分肾切除术发生率的影响。
我们使用Perspective数据库识别出2006年至2012年间53364例诊断为局限性肾细胞癌并接受切除手术的患者。手术程序根据手术范围（根治性肾切除术与部分肾切除术）、手术方式（开放、腹腔镜、机器人辅助）以及医院是否拥有手术机器人进行分类。采用多变量逻辑回归评估部分肾切除术比例随时间的变化以及购置手术机器人对部分肾切除术比例的影响。
2006年至2012年间共进行了40147例（75.2%）根治性肾切除术和13217例（24.8%）部分肾切除术。使用手术机器人进行肾癌手术的医院比例从2006年第一季度的1.8%增加到2012年底的47.7%。部分肾切除术的使用率在19.1%至31.2%之间。使用机器人辅助的医院比未使用机器人辅助的医院进行部分肾切除术的比例更高（29.6%对18.0%，p<0.001）。购置手术机器人后，部分肾切除术的比例从16.4%增加到34.3%（p<0.001）。拥有机器人的医院比根治性肾切除术更倾向于使用部分肾切除术（比值比1.464，置信区间1.39 - 1.54，p<0.001）。
虽然腹腔镜部分肾切除术仍然是一项具有挑战性的手术，但本研究表明，医院拥有手术机器人与在治疗局限性肾肿块时增加部分肾切除术的使用相关。
