Xu Liqing, Li Xinfei, Zhang Yiming, Li Zhihua, Yang Kunlin, Zhang Zhongyuan, Cai Lin, Shen Cheng, Zhou Liqun, Li Xuesong
Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, 100034, China.
World J Urol. 2024 Dec 23;43(1):44. doi: 10.1007/s00345-024-05395-2.
To develop a three-dimensional (3D) image based extended tumor plane technique for robotic-assisted partial nephrectomy (RAPN).
We prospectively enrolled patients with a local renal tumor for RAPN between March 2019 and Mar 2022. 3D virtual model was reconstructed based on the computed tomography urography. The tumor plane was extended equidistantly (10 mm) to form a virtual plane. According to the relationship between the extended plane and the collection system, patients are divided into those with no collecting system involvement, renal medulla involvement, and renal calyx involvement. The primary endpoint was trifecta achievement, which was defined as warm ischemic time ≤ 25 min, negative surgical margins, and no major perioperative complications.
This study enrolled a total of 215 patients. The median preoperative aspects and dimensions used for an anatomical (PADUA) score was 9 (6-15). The average warm ischemic time was 21.64 ± 9.35 min. Postoperative complications occurred in 26 (12.1%) patients, of whom 14 (6.5%) classified as major complication. The number of cases with trifecta failure was 1 (5.3%) in the no involvement group, 28 (20.6%) in the renal medullary involvement group, and 24 (40.0%) in the renal calyx involvement group (p < 0.001). Logistic regression indicated that renal calyx involvement was a risk factor for trifecta failure (OR = 2.639, 95% confidence interval [1.268-5.492], p = 0.009).
The extended tumor plane based on three-dimensional images can is useful for the evaluation of RAPN. Determining whether the extended plane involves the collecting system, particularly the renal calyx, may impact the achievement of trifecta.
开发一种基于三维（3D）图像的扩展肿瘤平面技术，用于机器人辅助部分肾切除术（RAPN）。
我们前瞻性纳入了2019年3月至2022年3月期间因RAPN而患有局部肾肿瘤的患者。基于计算机断层扫描尿路造影重建3D虚拟模型。肿瘤平面等距扩展（10毫米）以形成虚拟平面。根据扩展平面与集合系统的关系，将患者分为无集合系统受累、肾髓质受累和肾盏受累的患者。主要终点是达到三联成功，定义为热缺血时间≤25分钟、手术切缘阴性且无重大围手术期并发症。
本研究共纳入215例患者。术前解剖学（PADUA）评分的中位数为9（6-15）。平均热缺血时间为21.64±9.35分钟。26例（12.1%）患者发生术后并发症，其中14例（6.5%）为重大并发症。无受累组三联失败的病例数为1例（5.3%），肾髓质受累组为28例（20.6%），肾盏受累组为24例（40.0%）（p<0.001）。逻辑回归表明，肾盏受累是三联失败的危险因素（OR=2.639，95%置信区间[1.268-5.492]，p=0.009）。
基于三维图像的扩展肿瘤平面可用于评估RAPN。确定扩展平面是否涉及集合系统，特别是肾盏，可能会影响三联成功的实现。
