对比微创手术与根治性手术治疗 1 期肾细胞癌老年患者的生存及手术结局。

Comparisons of survival and surgical outcomes between minimally invasive partial nephrectomy and radical nephrectomy in elderly patients with stage 1 renal cell carcinoma.

机构信息

Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.

Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Japan.

出版信息

Geriatr Gerontol Int. 2024 Mar;24(3):269-274. doi: 10.1111/ggi.14808. Epub 2024 Jan 21.

DOI:10.1111/ggi.14808

PMID:38246656

Abstract

AIM

We compared survival and perioperative outcomes of robot-assisted laparoscopic partial nephrectomy (RAPN) and laparoscopic radical nephrectomy (LRN) for older patients (age 70 years or older) with stage 1 renal cell carcinoma (RCC).

METHODS

This retrospective, single-center study included 260 patients who underwent RAPN and 44 patients who underwent LRN. The overall survival (OS) and perioperative outcomes were compared between these two groups using an inverse probability of treatment weighting (IPTW) analysis.

RESULTS

Compared with the LRN group, a trend of more complications was observed in the RAPN group, including a higher body mass index (24 vs. 22 kg/m ; P = 0.0002) and higher rates of hypertension (77% vs. 55%; P = 0.0029) and chronic kidney disease (62% vs. 36%; P = 0.0027). After adjustment by the IPTW analysis, the RAPN group had a shorter operative time (143 vs. 282 min; P = 0.033), shorter postoperative length of hospital stay (PLOS) (4.1 vs. 7.9 days; P = 0.004), and less change in the estimated glomerular filtration rate during surgery (-8.4% vs. -32%; P < 0.0001) than the LRN group; however, the perioperative complication rates were similar. Patients who underwent RAPN had better 5-year OS than those who underwent LRN (95% vs. 90%; log-rank, P = 0.017).

CONCLUSION

RAPN resulted in better OS and surgical outcomes, with shorter operative time, shorter PLOS, and better renal function preservation, than LRN for older patients with stage 1 RCC. Therefore, RAPN may be the primary option for patients indicated for surgical intervention. Geriatr Gerontol Int 2024; 24: 269-274.

摘要

目的

我们比较了机器人辅助腹腔镜部分肾切除术（RAPN）和腹腔镜根治性肾切除术（LRN）治疗 70 岁及以上局限性肾细胞癌（RCC）患者的生存和围手术期结局。

方法

本回顾性单中心研究纳入了 260 例行 RAPN 和 44 例行 LRN 的患者。使用逆概率治疗加权（IPTW）分析比较两组之间的总生存期（OS）和围手术期结局。

结果

与 LRN 组相比，RAPN 组的并发症发生率更高，包括更高的体重指数（24 比 22kg/m2；P=0.0002）和更高的高血压发生率（77%比 55%；P=0.0029）和慢性肾脏病发生率（62%比 36%；P=0.0027）。通过 IPTW 分析调整后，RAPN 组的手术时间更短（143 比 282min；P=0.033），术后住院时间（PLOS）更短（4.1 比 7.9 天；P=0.004），术中估算肾小球滤过率的变化更小（-8.4%比-32%；P<0.0001），但围手术期并发症发生率相似。行 RAPN 的患者 5 年 OS 优于行 LRN 的患者（95%比 90%；对数秩检验，P=0.017）。