Grosso Antonio Andrea, Di Maida Fabrizio, Lambertini Luca, Cadenar Anna, Coco Simone, Ciaralli Elena, Salamone Vincenzo, Vittori Gianni, Tuccio Agostino, Mari Andrea, Minervini Andrea
Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic, Minimally-invasive Urology and Andrology, Careggi Hospital, Florence, Italy.
Urologia. 2024 Aug;91(3):568-573. doi: 10.1177/03915603241252905. Epub 2024 May 21.
To compare two cohorts of patients submitted to robot-assisted partial nephrectomy (RAPN) for highly-complex renal masses (PADUA ⩾ 10) with versus without the use of 3DVMs.
We screened a prospective consecutive cohort of 152 patients submitted to RAPN with 3DVM and 1264 patients submitted to RAPN without 3DVM between 2019 and 2022. Only PADUA ⩾ 10 cases were considered eligible for analysis. Propensity score matching (PSM) analysis was applied. Primary endpoint was to evaluate whereas RAPNs with 3DVM were superior in terms of functional outcomes at 12-month. Secondary outcomes were to compare perioperative and oncological outcomes. Multivariable logistic regression analyses (MVA) tested the associations of clinically significant eGFR drop and 3DVMs. Subgroups analysis was performed for PAUDA-risk categories.
Thirty seven patients for each group were analyzed after PSM. RAPN with 3DVM presented a higher rate of selective/no clamping procedure (32.5% vs 16.2%, = 0.03) and a higher enucleation rate (43.2% vs 29.8%, = 0.04). Twelve-month functional preservation performed better within 3DVM group in terms of creatinine serum level (median 1.2 [IQR 1.1-1.4] vs 1.6 [IQR 1.1-1.8], = 0.03) and eGFR (median 64.6 [IQR 56.2-74.1] vs 52.3 [IQR 49.2-74.1], = 0.03). MVA confirmed 3DVM as a protective factor for clinically significant eGFR drop in this subgroup of patients.
RAPN performed with the use of 3DVM assistance for PADUA ⩾ 10 cases resulted in lower incidence of global ischemia and higher rate of enucleations. The positive impact of such technology was found at 12-month follow-up.
比较两组接受机器人辅助部分肾切除术（RAPN）治疗高度复杂肾肿块（PADUA≥10）的患者，一组使用三维可视化模型（3DVMs），另一组未使用。
我们筛选了2019年至2022年间152例接受使用3DVMs的RAPN的前瞻性连续队列患者和1264例未使用3DVMs的RAPN患者。仅PADUA≥10的病例被认为符合分析条件。应用倾向评分匹配（PSM）分析。主要终点是评估使用3DVMs的RAPN在12个月时功能结局方面是否更优。次要结局是比较围手术期和肿瘤学结局。多变量逻辑回归分析（MVA）检验了具有临床意义的估算肾小球滤过率（eGFR）下降与3DVMs之间的关联。对PADUA风险类别进行亚组分析。
PSM后每组分析了37例患者。使用3DVMs的RAPN选择性/无阻断手术率更高（32.5%对16.2%，P = 0.03），剜除率更高（43.2%对29.8%，P = 0.04）。在3DVM组中，12个月时在血清肌酐水平（中位数1.2[四分位间距1.1 - 1.4]对1.6[四分位间距1.1 - 1.8]，P = 0.03）和eGFR（中位数64.6[四分位间距56.2 - 74.1]对52.3[四分位间距49.2 - 74.1]，P = 0.03）方面功能保留情况更好。MVA证实3DVMs是该亚组患者具有临床意义的eGFR下降的保护因素。
对于PADUA≥10的病例，使用3DVMs辅助进行RAPN可降低整体缺血发生率并提高剜除率。在12个月随访时发现了该技术的积极影响。
