Robotic Partial Nephrectomy for Clinical Stage T1b Tumors: Intermediate Oncologic and Functional Outcomes
Robotic Partial Nephrectomy for Clinical Stage T1b Tumors: Intermediate Oncologic and Functional Outcomes
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DOI：
10.1016/j.clgc.2014.07.011
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发表时间：
2015-02-01
影响因子：
3.2
通讯作者：
Lee, Benjamin R.
中科院分区：
文献类型：
--
作者：
Maddox, Michael;Mandava, Sree;Lee, Benjamin R.
尽管选择性保留肾单位的手术越来越多地用于T1级肾脏肿块，但关于临床T1级或更大（bbb4cm）肾脏病变的最适当处理仍然存在争议。现有的文献专门研究机器人部分肾切除术治疗这些较大的肾肿块的使用，仅限于少数观察性研究。根据我们的经验，机器人肾部分切除术是一种安全的手术，具有良好的中期肿瘤预后和良好的肾功能保存。目的：本研究的目的是研究机器人部分肾切除术治疗临床T1b肿瘤的中期肿瘤学和功能结果。部分肾切除术已成为治疗小肾肿块的金标准。近年来，在一些中心，微创肾部分切除术的适应症已扩展到更大、更复杂的肾肿块。材料与方法：2008年7月至2013年9月，我院共施行机器人肾部分切除术241例，其中临床>= T1b肿瘤46例。我们回顾了这组患者的中期功能和肿瘤预后。结果：46例患者中位年龄为55.5岁（四分位数范围[IQR]， 51-68岁），中位体重指数为31.6 (IQR, 27.4-38.9)，肿瘤直径5.0 cm (IQR, 4.1-5.2 cm)，肾肾测量评分7.1（范围，5-11）。35例确诊肾细胞癌，11例病理为良性。1例患者有确定的阳性切缘，2例患者有局灶性阳性切缘。中位随访24.3个月（范围2.3-61.1个月），总生存率、无复发生存率和癌症特异性生存率分别为97.1%、97.1%和100%。没有患者术后进行透析，术前和术后血清肌酐或肾小球滤过率使用肾脏疾病方程的饮食修正没有显著差异。结论：由于慢性肾功能不全的许多不良医学反应，许多机构正在扩大部分肾切除术的适应症。我们证明机器人部分肾切除术是一种安全有效的治疗T1b肾肿瘤的方法，具有良好的中间肿瘤和功能预后。
Despite the increased adoption of elective nephron-sparing surgery for T1 renal masses, controversy remains regarding the most appropriate management of clinical T1b or greater (> 4 cm) renal lesions. The available literature specifically investigating the use of robotic partial nephrectomy for these larger renal masses is limited to a few observational studies. In our experience, robotic partial nephrectomy for renal tumors > 4 cm is a safe procedure with excellent intermediate-term oncologic outcomes and good preservation of renal function.Objective: The objective of this study was to examine our intermediate oncologic and functional outcomes of robotic partial nephrectomy for clinical T1b tumors. Partial nephrectomy has become the gold standard of treatment for small renal masses. Recently, indications for minimally invasive partial nephrectomy have extended to larger and more complicated renal masses in some centers. Materials and Methods: Between July 2008 and September 2013, 241 robotic partial nephrectomies were performed at our institution, including 46 for clinical >= T1b tumors. We reviewed the intermediate-term functional and oncologic outcomes of this cohort of patients. Results: Of the 46 patients, the median age was 55.5 years ( interquartile range [IQR], 51-68 years) with a median body mass index of 31.6 (IQR, 27.4-38.9), tumor diameter of 5.0 cm (IQR, 4.1-5.2 cm), and RENAL nephrometry score of 7.1 (range, 5-11). Renal cell carcinoma was confirmed in 35 patients, and 11 patients had benign pathology. There was 1 patient with an established positive margin and 2 patients had a focal positive margin. At a median follow-up of 24.3 months (range, 2.3-61.1 months), the overall, recurrence-free and cancer-specific survival was 97.1%, 97.1%, and 100%, respectively. No patient progressed to dialysis postoperatively and there was no significant difference between preoperative and postoperative serum creatinine or estimated glomerular filtration rate using the Modification of Diet in Renal Disease equation. Conclusion: Because of the many adverse medical effects of chronic renal insufficiency, the indications for partial nephrectomy are expanding at many institutions. We demonstrated that robotic partial nephrectomy is a safe and efficacious procedure for the treatment of T1b renal tumors with excellent intermediate oncologic and functional outcomes.