Department of Urology, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Advanced Medical Initiatives, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Robot Surg. 2024 Aug 7;18(1):314. doi: 10.1007/s11701-024-02070-x.
Our objective was to investigate the long-term functional outcomes of robot-assisted partial nephrectomy (RAPN) combined with three-dimensional (3D) imaging. The 3D images, reconstructed using computed tomography, were introduced in RAPN procedures. The demographic, oncological, functional, and volumetric outcomes of 296 patients who underwent RAPN with and without 3D imaging between 2013 and 2021 were analyzed retrospectively. Propensity score matching (1:1) was performed to adjust for potential baseline confounders. After matching, 71 patients were allocated to each group. In the 3D RAPN (3DRPN) group, functional outcomes significantly improved: the number of patients with over 90% estimated glomerular filtration rate (eGFR) preservation rate (40 vs. 43, P = 0.044), eGFR preservation rate (88.0% vs. 91.6%, P = 0.006), the number of patients with chronic kidney disease (CKD) upstaging (26 vs. 13, P = 0.023), and split renal function preservation rate (operated kidney: 84.9% vs. 88.5%, P = 0.015). The 3DRPN group showed superiority in terms of >90% eGFR preservation (P = 0.010), CKD upstaging-free survival rates (P < 0.001), and volumetric outcomes (excess parenchymal volume: 27.9 vs. 17.7 mL, P = 0.030; parenchyma volume preservation rate: 81.6% vs. 88.8%, P = 0.006). Three-dimensional imaging was positively associated with eGFR preservation (P = 0.023, odds ratio: 2.34) and prevention of CKD upstaging (P = 0.013, odds ratio: 2.90). In this study, RAPN combined with 3D imaging underscored the preservation of eGFR > 90% and the prevention of CKD upstaging by improving the preservation rate of renal parenchyma and split renal function.
我们的目的是研究机器人辅助部分肾切除术（RAPN）结合三维（3D）成像的长期功能结果。使用 CT 重建的 3D 图像被引入 RAPN 手术中。回顾性分析了 2013 年至 2021 年间接受 RAPN 治疗且有或无 3D 成像的 296 例患者的人口统计学、肿瘤学、功能和体积学结果。采用倾向评分匹配（1:1）来调整潜在的基线混杂因素。匹配后，每组分配 71 例患者。在 3D RAPN（3DRPN）组中，功能结果显著改善：有超过 90%估算肾小球滤过率（eGFR）保留率的患者数量（40 例 vs. 43 例，P=0.044）、eGFR 保留率（88.0% vs. 91.6%，P=0.006）、慢性肾脏病（CKD）升级患者数量（26 例 vs. 13 例，P=0.023）和分肾功能保留率（手术侧肾脏：84.9% vs. 88.5%，P=0.015）。3DRPN 组在保留 eGFR>90%方面具有优势（P=0.010）、CKD 升级无进展生存率（P<0.001）和体积学结果（多余实质体积：27.9 毫升 vs. 17.7 毫升，P=0.030；实质体积保留率：81.6% vs. 88.8%，P=0.006）。3D 成像与 eGFR 保留呈正相关（P=0.023，优势比：2.34），与 CKD 升级的预防呈正相关（P=0.013，优势比：2.90）。在这项研究中，RAPN 结合 3D 成像通过提高肾实质和分肾功能的保留率，强调了 eGFR>90%的保留和 CKD 升级的预防。
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