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Abstract：
OBJECTIVE: To compare the long-term clinical and oncologic outcomes of laparoscopic partial nephrectomy (LPN) and laparoscopic radical nephrectomy (LRN) in patients with renal cell carcinoma (RCC) > 4 cm.
METHODS: We retrospectively reviewed the records of all patients who underwent LPN or LRN in our department from January 2012 to December 2017. Of the 151 patients who met the study selection criteria, 54 received LPN, and 97 received LRN. After propensity-score matching, 51 matched pairs were further analyzed. Data on patients\' surgical data, complications, histologic data, renal function, and survival outcomes were collected and analyzed.
RESULTS: Compared with the LRN group, the LPN group had a longer operative time (135 min vs. 102.5 min, p = 0.001), larger intraoperative bleeding (150 ml vs. 50 ml, p < 0.001), and required longer stays in hospital (8 days vs. 6 days, p < 0.001); however, the level of ECT-GFR was superior at 3, 6, and 12 months (all p < 0.001). Similarly, a greater number of LRN patients developed CKD compared with LPN until postoperative 12 months (58.8% vs. 19.6%, p < 0.001). In patients with preoperative CKD, LPN may delay the progression of the CKD stage and even improve it when compared to LRN treatment. There were no significant differences between the two groups for OS, CSS, MFS, and PFS (p = 0.06, p = 0.30, p = 0.90, p = 0.31, respectively). The surgical method may not be a risk factor for long-term survival prognosis.
CONCLUSIONS: LPN preserves renal function better than LRN and has the potential value of significantly reducing the risk of postoperative CKD, but the long-term survival prognosis of patients is comparable.
METHODS: We retrospectively reviewed the records of all patients who underwent LPN or LRN in our department from January 2012 to December 2017. Of the 151 patients who met the study selection criteria, 54 received LPN, and 97 received LRN. After propensity-score matching, 51 matched pairs were further analyzed. Data on patients\' surgical data, complications, histologic data, renal function, and survival outcomes were collected and analyzed.
RESULTS: Compared with the LRN group, the LPN group had a longer operative time (135 min vs. 102.5 min, p = 0.001), larger intraoperative bleeding (150 ml vs. 50 ml, p < 0.001), and required longer stays in hospital (8 days vs. 6 days, p < 0.001); however, the level of ECT-GFR was superior at 3, 6, and 12 months (all p < 0.001). Similarly, a greater number of LRN patients developed CKD compared with LPN until postoperative 12 months (58.8% vs. 19.6%, p < 0.001). In patients with preoperative CKD, LPN may delay the progression of the CKD stage and even improve it when compared to LRN treatment. There were no significant differences between the two groups for OS, CSS, MFS, and PFS (p = 0.06, p = 0.30, p = 0.90, p = 0.31, respectively). The surgical method may not be a risk factor for long-term survival prognosis.
CONCLUSIONS: LPN preserves renal function better than LRN and has the potential value of significantly reducing the risk of postoperative CKD, but the long-term survival prognosis of patients is comparable.
摘要：
目的：比较腹腔镜下肾部分切除术（LPN）和腹腔镜下根治性肾切除术（LRN）治疗肾细胞癌（RCC）>4cm患者的长期临床和肿瘤疗效。
方法：我们回顾性回顾了2012年1月至2017年12月在我科接受LPN或LRN的所有患者的记录。在符合研究选择标准的151名患者中，54收到LPN，97人获得了LRN。在倾向得分匹配后，进一步分析了51对配对。患者手术数据，并发症,组织学资料,肾功能,收集和分析生存结局.
结果：与LRN组相比，LPN组手术时间较长(135分钟vs.102.5分钟,p=0.001),术中出血较大（150mlvs.50ml,p<0.001)，并要求住院时间更长(8天vs.6天,p<0.001)；然而，ECT-GFR水平在3,6和12个月时均较好(均p<0.001).同样，与LPN相比，更多的LRN患者在术后12个月前发展为CKD(58.8%vs.19.6%,p<0.001)。在术前CKD患者中，与LRN治疗相比，LPN可以延迟CKD阶段的进展，甚至可以改善CKD阶段。两组间OS无显著差异,CSS,MFS,和PFS(分别为p=0.06,p=0.30,p=0.90,p=0.31)。手术方法可能不是长期生存预后的危险因素。
结论：LPN比LRN更好地保留肾功能，并且具有显着降低术后CKD风险的潜在价值。但患者的长期生存预后相当。
方法：我们回顾性回顾了2012年1月至2017年12月在我科接受LPN或LRN的所有患者的记录。在符合研究选择标准的151名患者中，54收到LPN，97人获得了LRN。在倾向得分匹配后，进一步分析了51对配对。患者手术数据，并发症,组织学资料,肾功能,收集和分析生存结局.
结果：与LRN组相比，LPN组手术时间较长(135分钟vs.102.5分钟,p=0.001),术中出血较大（150mlvs.50ml,p<0.001)，并要求住院时间更长(8天vs.6天,p<0.001)；然而，ECT-GFR水平在3,6和12个月时均较好(均p<0.001).同样，与LPN相比，更多的LRN患者在术后12个月前发展为CKD(58.8%vs.19.6%,p<0.001)。在术前CKD患者中，与LRN治疗相比，LPN可以延迟CKD阶段的进展，甚至可以改善CKD阶段。两组间OS无显著差异,CSS,MFS,和PFS(分别为p=0.06,p=0.30,p=0.90,p=0.31)。手术方法可能不是长期生存预后的危险因素。
结论：LPN比LRN更好地保留肾功能，并且具有显着降低术后CKD风险的潜在价值。但患者的长期生存预后相当。
