Lin Ren-Jie, Hsieh Chia-Chih, Tseng Wen-Hsin, Liu Chien-Liang, Huang Steven K, Chiu Allen W
Department of General Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.
BMC Urol. 2025 May 2;25(1):111. doi: 10.1186/s12894-025-01786-8.
Partial nephrectomy (PN) has been the main strategy for treating cT1 (≤ 7 cm) renal tumors. Previous studies have established PN's safety and effectiveness over radical nephrectomy (RN) for cT1 tumors. However, the efficacy and safety of retroperitoneal PN for larger renal tumors (> 7 cm) remained controversial. Through a size-based comparative analysis of cT1 and cT2 tumors undergoing retroperitoneal PN, we explored the impact of renal tumors larger than 7 cm on perioperative, oncological, and functional outcomes.
From January 2017 to April 2021, we collected data from 201 patients undergoing retroperitoneal laparoscopic or robot-assisted PN. Of these, 173 (86.1%) had tumors ≤ 7 cm (Group A) and 28 (13.9%) had tumors > 7 cm (Group B). We analyzed demographics (gender, age, Body Mass Index, Charlson Comorbidity Index, preoperative hemoglobin and renal function, tumor location, operative method, RENAL score, and complexity), perioperative (operative time, warm ischemic time, estimated blood loss, hospital stay, surgical margins, complications), and functional outcomes (changes in renal function pre- and postoperatively), along with recurrence rates.
Mean tumor sizes in Group A and Group B were 3.67 ± 1.56 cm and 9.90 ± 2.97 cm, respectively. RENAL score analysis revealed a significant difference (7.64 vs. 9.21, P < 0.0001), attributed to the Radius and Exophytic/Endophytic property parameters. Furthermore, Group B exhibited significantly higher tumor complexity(P = 0.0009). In perioperative outcomes, Group B had a prolonged warm ischemic time (18.90 vs. 22.60 min, P = 0.0486). However, there was no significant difference in estimated blood loss and complication rates. Regarding functional outcomes, only the reduction of estimated glomerular filtration rate on postoperative day 1 was significant (-0.74 vs. -8.31, p = 0.016), with no significant differences at 3 months, 6 months, or 1 year postoperatively. For eGFR changes over time in Group B, declines at postoperative month 3 and postoperative year 1 were noted.
Despite higher preoperative RENAL scores and prolonged perioperative warm ischemic time, retroperitoneal PN for tumors > 7 cm demonstrated acceptable functional, oncological, and perioperative outcomes, with no observed gastrointestinal complications. Our findings support its feasibility as a treatment option for patients with > 7 cm or intermediate/high complexity renal tumors.
部分肾切除术（PN）一直是治疗cT1（≤7cm）肾肿瘤的主要策略。既往研究已证实PN治疗cT1肿瘤相对于根治性肾切除术（RN）的安全性和有效性。然而，腹膜后PN治疗较大肾肿瘤（>7cm）的疗效和安全性仍存在争议。通过对接受腹膜后PN的cT1和cT2肿瘤进行基于大小的比较分析，我们探讨了大于7cm的肾肿瘤对围手术期、肿瘤学及功能结局的影响。
2017年1月至2021年4月，我们收集了201例行腹膜后腹腔镜或机器人辅助PN患者的数据。其中，173例（86.1%）肿瘤≤7cm（A组），28例（13.9%）肿瘤>7cm（B组）。我们分析了人口统计学特征（性别、年龄、体重指数、Charlson合并症指数、术前血红蛋白和肾功能、肿瘤位置、手术方式、RENAL评分及复杂性）、围手术期情况（手术时间、热缺血时间、估计失血量、住院时间、手术切缘、并发症）和功能结局（术前和术后肾功能变化）以及复发率。
A组和B组的平均肿瘤大小分别为3.67±1.56cm和9.90±2.97cm。RENAL评分分析显示存在显著差异（7.64对9.21，P<0.0001），这归因于半径和外生性/内生性特征参数。此外，B组的肿瘤复杂性显著更高（P=0.0009）。在围手术期结局方面，B组的热缺血时间延长（18.90对22.60分钟，P=0.0486）。然而，估计失血量和并发症发生率无显著差异。关于功能结局，仅术后第1天估计肾小球滤过率的下降有显著差异（-0.74对-8.31，p=0.016），术后3个月、6个月或1年无显著差异。对于B组随时间的eGFR变化，术后第3个月和术后第1年出现下降。
尽管术前RENAL评分较高且围手术期热缺血时间延长，但腹膜后PN治疗>7cm的肿瘤仍显示出可接受的功能、肿瘤学及围手术期结局，未观察到胃肠道并发症。我们的研究结果支持其作为治疗>7cm或中/高复杂性肾肿瘤患者的一种可行治疗选择。
