Umbehr Martin H, Jenni Simon, Fischer Boris, Zimmermann Matthias, Steigmiller Klaus, Müntener Michael
Clinic for Urology, Municipal Hospital Triemli of Zurich, Zurich, Switzerland.
Epidemiology, Biostatistics and Prevention Institute, Biostatistics Department, University of Zurich, Zurich, Switzerland.
Curr Urol. 2024 Dec;18(4):323-327. doi: 10.1097/CU9.0000000000000102. Epub 2024 Dec 20.
Partial nephrectomy (PN) is considered the gold standard surgical treatment for renal masses < 7cm in size (T1 tumors). Since the introduction of the robotic-assisted laparoscopic PN (raPN) in high-volume centers, it has been increasingly adapted and standardized by urologists worldwide. There is growing evidence that the robot-assisted laparoscopic technique is associated with superior outcomes compared to those of open and conventional laparoscopic techniques. This study aimed to summarize the contemporary outcome data of raPN for renal tumors with varying degrees of complexity and to assess whether the outcomes reported from high-volume centers are reproducible in a limited caseload setting.
This was a retrospective study of a single surgeon's experience, including 123 consecutive patients undergoing raPN at our institution. Ultimately, 110 patients were included in the analysis. Basic characteristics, tumor complexity as described by the RENAL score, complications described by the Clavien-Dindo classification system, and functional and oncological outcomes were assessed and analyzed statistically.
Of the 110 patients, 27 (24%), 61 (55%), and 23 (21%) had low, intermediate, and high degrees of complexity, respectively, according to the RENAL score. A cancer-negative surgical margin was achieved in 108 (97%) patients. A total of 70 (64%) patients had no loss of renal function, while 20 (27%) had minimal loss of renal function. Complications of > 3 Clavien-Dindo classification during the first 30 postoperative days occurred in 5 (5%) patients. The 3 complexity groups were found to have significantly different ischemia time: Low, 8 minutes (interquartile range [IQR], 8-9.5); Intermediate, 12 minutes (IQR, 10-13); and High, 15.5 minutes (IQR, 11.25-18.75) ( 0.001). There were no significant differences between the groups.
Contemporary standards for raPN are safe and reproducible. Adherence to the technique reported by centers of excellence yielded comparable results with regard to tumor control, preservation of renal function, and complication rates in lower-volume settings.
部分肾切除术（PN）被认为是治疗直径小于7cm肾肿块（T1期肿瘤）的金标准手术方法。自从在大型医疗中心引入机器人辅助腹腔镜部分肾切除术（raPN）以来，该技术已被全球泌尿外科医生越来越多地采用并标准化。越来越多的证据表明，与开放手术和传统腹腔镜技术相比，机器人辅助腹腔镜技术具有更好的治疗效果。本研究旨在总结raPN治疗不同复杂程度肾肿瘤的当代疗效数据，并评估在手术量有限的情况下，大型医疗中心报告的疗效是否具有可重复性。
这是一项对单一外科医生经验的回顾性研究，包括在我们机构连续接受raPN治疗的123例患者。最终，110例患者纳入分析。评估并统计分析患者的基本特征、用RENAL评分描述的肿瘤复杂性、用Clavien-Dindo分类系统描述的并发症以及功能和肿瘤学结局。
根据RENAL评分，110例患者中，分别有27例（24%）、61例（55%）和23例（21%）具有低、中、高不同程度的复杂性。108例（97%）患者实现了切缘阴性。共有70例（64%）患者肾功能无损失，20例（27%）患者肾功能有轻微损失。术后30天内Clavien-Dindo分类>3级的并发症发生在5例（5%）患者中。发现3个复杂性组的缺血时间有显著差异：低复杂性组为8分钟（四分位数间距[IQR]，8 - 9.5）；中等复杂性组为12分钟（IQR，10 - 13）；高复杂性组为15.5分钟（IQR，11.25 - 18.75）（ 0.001）。各组之间无显著差异。
raPN的当代标准是安全且可重复的。在手术量较低的情况下，遵循卓越中心报告的技术在肿瘤控制、肾功能保留和并发症发生率方面产生了可比的结果。
