机器人辅助的多肿瘤部分肾切除术：一项多中心分析

Robot-assisted partial nephrectomy of multiple tumors: a multicenter analysis.

作者信息

Faraj Tabrizi Pouriya, Zeuschner Philip, Katzendorn Olga, Schiefelbein Frank, Schneller Andreas, Schoen Georg, Ubrig Burkhard, Gloger Simon, Wiesinger Clemens G, Pfuner Jacob, Falkensammer Eva, Eraky Ahmed, Osmonov Daniar, Nuhn Philipp, Zimmermanns Volker, Paramythelli Ionna, Hadaschik Boris A, Radtke Jan P, Darr Christopher, Gilbert Nils, Kriegmair Maximilian, Fuhrmann Christian, Kuczyk Markus A, Harke Nina N

机构信息

Hannover Medical School, Department of Urology and Urological Oncology, Hannover, Germany.

Department of Urology and Pediatric Urology, Saarland University, Homburg, Germany.

出版信息

Minerva Urol Nephrol. 2024 Dec;76(6):698-707. doi: 10.23736/S2724-6051.24.05816-6. Epub 2024 Nov 28.

DOI:10.23736/S2724-6051.24.05816-6

PMID:39607672

Abstract

BACKGROUND

Robot-assisted partial nephrectomy (RAPN) is increasingly performed in challenging tumor constellations like multiple renal masses.

METHODS

The objective was to investigate influencing factors on postoperative renal function (PRF) after ipsilateral robot-assisted partial nephrectomy of multiple tumors (iRAPN-MT). In this retrospective multicenter study, perioperative data of 132 trans- or retroperitoneal iRAPN-MT for ≥ two tumors were analyzed focusing on influencing factors on PRF and acute kidney injury including RIFLE and trifecta criteria. The impact of patient-, surgery- and tumor-related factors was investigated via uni- and multivariate regression analyses.

RESULTS

The majority of patients had two renal masses, with three or more lesions in 19%. Median operative time was 175 minutes. Eighty-five percent of the tumors were dissected on-clamp with a median cumulative warm ischemia time (WITsum) of 15 minutes. Trifecta criteria were fulfilled in 57%. In regression analyses, WITsum, BMI and preoperative eGFR had an impact on eGFR loss before discharge (median -11.6 mL/min). BMI and Charlson Comorbidity Index were independent predictors for the lowest RIFLE stage during hospitalization.

CONCLUSIONS

iRAPN-MT for multiple ipsilateral renal masses is feasible with good trifecta rates. While mostly unmodifiable patient-associated parameters were independent predictors on PRF impairment, WITsum was identified as a surgery-related independent parameter.

摘要

背景

机器人辅助部分肾切除术（RAPN）越来越多地应用于处理具有挑战性的肿瘤情况，如多发性肾肿块。

方法

目的是研究同侧机器人辅助多发性肿瘤部分肾切除术（iRAPN-MT）后影响术后肾功能（PRF）的因素。在这项回顾性多中心研究中，分析了132例经腹腔或腹膜后iRAPN-MT治疗≥两个肿瘤的围手术期数据，重点关注影响PRF和急性肾损伤的因素，包括RIFLE标准和三连胜标准。通过单因素和多因素回归分析研究患者、手术和肿瘤相关因素的影响。

结果

大多数患者有两个肾肿块，19%有三个或更多病灶。中位手术时间为175分钟。85%的肿瘤在阻断下进行解剖，中位累计热缺血时间（WITsum）为15分钟。57%的患者达到三连胜标准。在回归分析中，WITsum、BMI和术前估算肾小球滤过率（eGFR）对出院前eGFR下降有影响（中位下降-11.6 mL/min）。BMI和Charlson合并症指数是住院期间最低RIFLE分期的独立预测因素。