Pitout Alice, Margue Gaëlle, Rubat Baleuri Federico, Khaddad Abderrahmane, Pattou Maxime, Bladou Franck, Robert Grégoire, Bernhard Jean-Christophe
Urology Department, Bordeaux University Hospital, 33000 Bordeaux, France.
I.CaRe Bordeaux-BRIC Inserm U1312, 33200 Bordeaux, France.
Cancers (Basel). 2025 Jun 25;17(13):2127. doi: 10.3390/cancers17132127.
BACKGROUND/OBJECTIVES: Three-dimensional (3D) image-guided robotic-assisted partial nephrectomy (3D-IGRAPN) integrates patient-specific anatomical models to optimize surgical planning and intraoperative guidance in the management of renal tumors. This study aimed to assess medium-term functional and oncologic outcomes of 3D-IGRAPN in a large, prospective cohort.
All consecutive patients undergoing 3D-IGRAPN between January 2016 and March 2023 at a tertiary referral center were prospectively included in the UroCCR database (NCT03293563). Patient-specific 3D models were generated from preoperative CT scans and used intraoperatively. The primary endpoint was trifecta achievement, defined as an absence of major complications (Clavien-Dindo ≥ 3), negative surgical margins for malignant tumors, and ≥90% preservation of baseline renal function at 3 months. Secondary endpoints included functional outcomes, complication rates, local recurrence, and metastasis rates, as well as cancer-specific and overall survivals.
Among 568 patients (586 surgeries), the trifecta was achieved in 55.2% of evaluable malignant cases. Severe complications occurred in 33 cases (5.6%), and positive surgical margins were reported in 27 cases (5.1%) out of 528 surgeries involving malignant lesions. Renal function was preserved in 59.9% of patients at 3 months. At a mean follow-up of 31.5 months, recurrence and metastasis rates were 7.4% and 8.6%, respectively. Cancer-specific and overall survival at follow-up were 96.5% and 89%.
3D-IGRAPN demonstrates favorable functional and oncologic outcomes, even in complex tumors. These results support the integration of 3D modeling as a standard tool in image-guided nephron-sparing surgery.
背景/目的：三维（3D）图像引导机器人辅助部分肾切除术（3D-IGRAPN）整合了患者特异性解剖模型，以优化肾肿瘤治疗中的手术规划和术中引导。本研究旨在评估大型前瞻性队列中3D-IGRAPN的中期功能和肿瘤学结局。
2016年1月至2023年3月在一家三级转诊中心接受3D-IGRAPN的所有连续患者均被前瞻性纳入UroCCR数据库（NCT03293563）。从术前CT扫描生成患者特异性3D模型并在术中使用。主要终点是三连胜达成，定义为无重大并发症（Clavien-Dindo≥3级）、恶性肿瘤手术切缘阴性以及3个月时基线肾功能保留≥90%。次要终点包括功能结局、并发症发生率、局部复发和转移率，以及癌症特异性生存率和总生存率。
在568例患者（586次手术）中，55.2%的可评估恶性病例实现了三连胜。33例（5.6%）发生严重并发症，在涉及恶性病变的528次手术中，27例（5.1%）报告手术切缘阳性。3个月时59.9%的患者肾功能得以保留。平均随访31.5个月时，复发率和转移率分别为7.4%和8.6%。随访时癌症特异性生存率和总生存率分别为96.5%和89%。
3D-IGRAPN显示出良好的功能和肿瘤学结局，即使在复杂肿瘤中也是如此。这些结果支持将3D建模作为图像引导保留肾单位手术的标准工具加以整合。
