Frantz Ulysse, Bouvier Antoine, Culty Thibaut, Zidane Merzouka, Lebdai Souhil, Bigot Pierre
Department of Urology, Angers University Hospital, 49000 Angers, France.
Department of Radiology, Angers University Hospital, 49000 Angers, France.
J Clin Med. 2023 Aug 8;12(16):5167. doi: 10.3390/jcm12165167.
Laparoscopic partial nephrectomy (LPN) after hyperselective embolization of tumor vessels (HETV) in a hybrid operating room (HOR) that combines traditional surgical equipment with advanced imaging technology, is a non-clamping surgical approach to treat localized kidney tumors that has shown promising short-term results. The aim of this study was to evaluate the long-term oncological and functional outcomes of this procedure. All consecutive patients treated for a localized kidney tumor by LPN after HETV between May 2015 and October 2022 in a single academic institution were included in the study. Clinical, pathological and biological data were collected prospectively in the uroCCR database. We evaluated intraoperative data, postoperative complications, surgical margin and modification of renal function after surgery. We included 245 patients. The median tumor size was 3.2 (2.5-4.4) cm. The R.E.N.A.L. complexity was low, medium and high for 104 (43.5%), 109 (45.6%) and 26 (10.9%) patients, respectively. Median LPN time was 75 (65-100) min and median blood loss was 100 (50-300) mL. Surgical postoperative complications occurred in 56 (22.9%) patients with 17 (5.7%) major complications. The median Glomerular Function Rate variation at 6 months was -7.5 (-15--2) mL/min. Malignant tumors were present in 211 (86.1%) patients, and 12 (4.9%) patients had positive surgical margins. After a median follow-up of 27 (8-49) months, 20 (8.2%) patients had a tumor recurrence and 4 (1.6%) died from cancer. At 5 years, disease free survival, cancer specific survival and overall survival rates were 84%, 96.8% and 88.3%, respectively. Performing LPN after HETV in a HOR is a safe and efficient non-clamping approach to treat localized kidney tumors.
在结合了传统手术设备与先进成像技术的杂交手术室（HOR）中，对肿瘤血管进行超选择性栓塞（HETV）后行腹腔镜部分肾切除术（LPN），是一种治疗局限性肾肿瘤的非阻断性手术方法，已显示出良好的短期效果。本研究的目的是评估该手术的长期肿瘤学和功能结果。2015年5月至2022年10月期间，在一家学术机构接受HETV后行LPN治疗局限性肾肿瘤的所有连续患者均纳入本研究。临床、病理和生物学数据前瞻性收集于uroCCR数据库。我们评估了术中数据、术后并发症、手术切缘和术后肾功能改变。我们纳入了245例患者。肿瘤中位大小为3.2（2.5 - 4.4）cm。R.E.N.A.L. 复杂性低、中、高的患者分别为104例（43.5%）、109例（45.6%）和26例（10.9%）。LPN中位时间为75（65 - 100）分钟，中位失血量为100（50 - 300）mL。56例（22.9%）患者发生手术相关术后并发症，其中17例（5.7%）为严重并发症。6个月时肾小球滤过率变化中位数为 - 7.5（- 15 - - 2）mL/分钟。211例（86.1%）患者为恶性肿瘤，12例（4.9%）患者手术切缘阳性。中位随访27（8 - 49）个月后，20例（8.2%）患者出现肿瘤复发，4例（1.6%）患者死于癌症。5年时，无病生存率、癌症特异性生存率和总生存率分别为84%、96.8%和88.3%。在杂交手术室中HETV后行LPN是一种治疗局限性肾肿瘤的安全有效的非阻断性方法。
