Multiple Tumor Excisions in Ipsilateral Kidney Increase Complications After Partial Nephrectomy.
Multiple Tumor Excisions in Ipsilateral Kidney Increase Complications After Partial Nephrectomy.
复制标题
同侧肾脏的多个肿瘤切除会增加部分肾切除术后的并发症。
作者：
M. Maurice;D. Ramirez;R. Nelson;Peter A. Caputo;Ö. Kara;E. Malkoç;J. Kaouk
介绍
同侧同步性多灶性（ISM）的手术发病率特征不明显。我们评估了ISM对机器人肾部分切除术（RPN）后并发症的影响。
患者和方法
我们提取了2006年至2015年在我们机构进行的RPN病例的数据。多灶性疾病的特征是术前影像学上>1个肾脏肿块或RPN期间>1个肿块切除。主要结局是总体术后并发症发生率。采用单变量和多变量分析评价多灶性和并发症之间的关系。
结果
在1121例患者中，59例（5.3%）有1个以上的同侧肾肿块，50例（4.5%）需要1次以上的切除。总并发症发生率为20.3%（230/1121）。同侧肾脏肿块的影像学数量与并发症无显著相关性（1个肿块为20.2%，>1个肿块为25.4%，p = 0.338）。然而，在RPN期间进行的同侧肿块切除术的实际数量与并发症显著相关（≤2次切除术为20.2%，>2次切除术为42.9%，p = 0.037）。>2次切除与≤2次切除相比，严重并发症更高（14.3% vs. 5.3%），但差异不显著（p = 0.174）。与多处切除相关的最常见并发症为输血、尿漏、心律失常、静脉血栓栓塞和肠梗阻。在多变量分析中，切除次数独立预测并发症（OR 3.1，95% CI 1.03-9.33，p = 0.041）。并发症的其他独立预测因素包括年龄、种族、Charlson评分、体重指数、RENAL评分和外科医生经验。
结论
需要≥2次切除的ISM与RPN后发病率增加相关。在等待外部验证时，这些信息可能有助于临床决策和术前患者咨询。
INTRODUCTION
The surgical morbidity of ipsilateral synchronous multifocality (ISM) is poorly characterized. We assessed the impact of ISM on complications after robotic partial nephrectomy (RPN).
PATIENTS AND METHODS
We abstracted data on RPN cases performed between 2006 and 2015 at our institution. Multifocal disease was characterized by >1 renal mass on preoperative imaging or >1 mass excision during RPN. The primary outcome was the rate of overall postoperative complications. The association between multifocality and complications was evaluated using univariate and multivariable analyses.
RESULTS
Of 1121 cases, 59 (5.3%) had >1 ipsilateral renal mass and 50 (4.5%) required >1 excision. The overall complication rate was 20.3% (230/1121). The radiographic number of ipsilateral renal masses was not significantly associated with complications (20.2% for 1 mass vs. 25.4% for >1 mass, p = 0.338). However, the actual number of ipsilateral mass excisions performed during RPN was significantly associated with complications (20.2% for ≤2 excisions vs. 42.9% for >2 excisions, p = 0.037). Major complications were higher (14.3% vs. 5.3%) for >2 versus ≤2 excision(s), but this difference was not significant (p = 0.174). The most common complications associated with multiple excisions were transfusion, urine leak, arrhythmia, venous thromboembolism, and ileus. On multivariable analysis, number of excisions independently predicted complications (OR 3.1, 95% CI 1.03-9.33, p = 0.041). Other independent predictors of complications included age, race, Charlson score, body mass index, RENAL score, and surgeon experience.
CONCLUSIONS
ISM requiring ≥2 excisions is associated with increased morbidity after RPN. Pending external validation, this information may facilitate clinical decision-making and preoperative patient counseling.