Barletta Francesco, Frego Nicola, de Angelis Mario, Resca Stefano, Ticonosco Marco, Vecchio Enrico, Tamburini Sara, Pissavini Alessandro, Mourullo Andrea Noya, Kroon Bin K, Smits Geert, Papenburg Bernke, Lambert Edward, D'Hondt Frederick, De Groote Ruben, Schatteman Peter, Mottrie Alexandre, De Naeyer Geert
Unit of Urology, Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
Department of Urology, AZORG, 9300 Aalst, Belgium.
Cancers (Basel). 2025 Jun 23;17(13):2104. doi: 10.3390/cancers17132104.
Available guidelines recommend performing nephron-sparing surgery in selected renal cell carcinoma (RCC) patients. Many studies provided robot-assisted partial nephrectomy (RAPN) functional and oncological outcomes, with most of these including a wide timespan and a number of surgeons with different experiences, which might lead to the heterogeneity of the results. In this study, we aim to provide a contemporary report of RAPN patient outcomes performed at two referral centers by experienced surgeons. Overall, 333 RAPN patients treated at two European referral centers between 2019 and 2021 were identified. Continuous and categorical variables were reported using medians and proportions. Multi-variable logistic regression (MLR) models were fitted to test predictors of off-clamp technique use and trifecta achievement. : The median age was 65 (IQR: 57-73) years. The clinical stage distribution was as follows: 224 (67%) cT1a vs. 89 (26%) cT1b vs. 20 cT2 (7%). The median warm ischemia time was 14 (10-18) minutes, with trifecta being achieved in 74% (n = 240) of patients. In MLR models predicting off-clamp surgery, an increasing R.E.N.A.L. score was independently associated with a lower chance of attempting such a technique (OR: 0.69, -value < 0.001). In models predicting trifecta achievement, both a higher R.E.N.A.L. score (OR: 0.78, -value = 0.007) and the presence of multiple lesions (OR: 0.29, -value = 0.007) were independently associated with lower chances of reaching the outcome. Significant upstaging of chronic kidney disease (CKD) stage was recorded in 9.4% of patients after one year of follow-up. : We reported the contemporary outcomes of patients treated with RAPN by highly experienced surgeons from two referral centers. This report represents a valid benchmark that could be used for individual patient counseling in the decision-making process.
现有指南建议对部分肾细胞癌（RCC）患者进行保留肾单位手术。许多研究提供了机器人辅助部分肾切除术（RAPN）的功能和肿瘤学结果，其中大多数研究涵盖了较长的时间跨度且涉及多位经验不同的外科医生，这可能导致结果的异质性。在本研究中，我们旨在提供一份由经验丰富的外科医生在两个转诊中心进行RAPN手术患者结局的当代报告。总体而言，确定了2019年至2021年间在两个欧洲转诊中心接受治疗的333例RAPN患者。连续变量和分类变量分别采用中位数和比例进行报告。采用多变量逻辑回归（MLR）模型来检验无阻断技术使用和三联成功的预测因素。中位年龄为65（四分位间距：57 - 73）岁。临床分期分布如下：224例（67%）为cT1a期，89例（26%）为cT1b期，20例（7%）为cT2期。中位热缺血时间为14（10 - 18）分钟，74%（n = 240）的患者实现了三联成功。在预测无阻断手术的MLR模型中，R.E.N.A.L.评分增加与尝试该技术的可能性降低独立相关（比值比：0.69，P值<0.001）。在预测三联成功的模型中，较高的R.E.N.A.L.评分（比值比：0.78，P值 = 0.007）和存在多个病灶（比值比：0.29，P值 = 0.007）均与达到该结局的可能性降低独立相关。随访一年后，9.4%的患者慢性肾脏病（CKD）分期出现显著上调。我们报告了来自两个转诊中心的经验丰富的外科医生对接受RAPN治疗患者的当代结局。本报告是一个有效的基准，可用于决策过程中对个体患者的咨询。
