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Abstract：
BACKGROUND: Prolonged laparoscopic nephroureterectomy (LNU) for upper tract urothelial cancer (UTUC) can increase the frequency of intravesical recurrence after surgery. Therefore, it is important for urological surgeons to have knowledge on preoperative risk factors for prolonged LNU. However, few studies have investigated the risk factors for prolonged LNU. We hypothesized that the quantity of perirenal fat affects the pneumoretroperitoneum time (PRT) of retroperitoneal LNU (rLNU). This study aimed to investigate the preoperative risk factors for prolonged PRT during rLNU.
METHODS: We reviewed the data of 115 patients who underwent rLNU for UTUC between 2013 and 2021. The perirenal fat thickness (PFT) observed on preoperative computed tomography (CT) images was used to evaluate the perinephric fat quantity. Preoperative risk factors for PRT during rLNU were analyzed using logistic regression models. The cutoff value for PRT was determined based on the median time.The cutoff values for fat-related factors influencing PRT were defined according to receiver operating characteristic curve analysis.
RESULTS: The median PRT for rLNU was 182 min (interquartile range, 155-230 min). The cutoff values of posterior, lateral, and anterior PFTs were 15 mm, 24 mm, and 6 mm, respectively. Multivariate analysis revealed that a posterior PFT ≥ 15 mm (odds ratio [OR], 2.72; 95% confidence interval, 1.04-7.08; p = 0.0410) was an independent risk factor for prolonged PRT.
CONCLUSIONS: Thick posterior PFT is a preoperative risk factor for prolonged PRT during rLNU. For patients with UTUC and thick posterior PFT, surgeons should develop optimal surgical strategies, including the selecting an expert surgeon as a primary surgeon and the selecting transperitoneal approach to surgery or open surgery.
METHODS: We reviewed the data of 115 patients who underwent rLNU for UTUC between 2013 and 2021. The perirenal fat thickness (PFT) observed on preoperative computed tomography (CT) images was used to evaluate the perinephric fat quantity. Preoperative risk factors for PRT during rLNU were analyzed using logistic regression models. The cutoff value for PRT was determined based on the median time.The cutoff values for fat-related factors influencing PRT were defined according to receiver operating characteristic curve analysis.
RESULTS: The median PRT for rLNU was 182 min (interquartile range, 155-230 min). The cutoff values of posterior, lateral, and anterior PFTs were 15 mm, 24 mm, and 6 mm, respectively. Multivariate analysis revealed that a posterior PFT ≥ 15 mm (odds ratio [OR], 2.72; 95% confidence interval, 1.04-7.08; p = 0.0410) was an independent risk factor for prolonged PRT.
CONCLUSIONS: Thick posterior PFT is a preoperative risk factor for prolonged PRT during rLNU. For patients with UTUC and thick posterior PFT, surgeons should develop optimal surgical strategies, including the selecting an expert surgeon as a primary surgeon and the selecting transperitoneal approach to surgery or open surgery.
摘要：
背景：延长腹腔镜肾输尿管切除术（LNU）治疗上尿路尿路上皮癌（UTUC）可增加术后膀胱内复发的频率。因此,对于泌尿外科医师来说,了解长期LNU的术前危险因素非常重要.然而,很少有研究调查延长LNU的危险因素。我们假设肾周脂肪的数量会影响腹膜后LNU（rLNU）的气腹时间（PRT）。本研究旨在探讨rLNU期间延长PRT的术前危险因素。
方法：我们回顾了2013年至2021年间接受rLNU治疗UTUC的115例患者的数据。术前计算机断层扫描（CT）图像上观察到的肾周脂肪厚度（PFT）用于评估肾周脂肪量。采用logistic回归模型分析rLNU期间PRT的术前危险因素。基于中位时间确定PRT的截止值。根据受试者工作特征曲线分析确定影响PRT的脂肪相关因素的截止值。
结果：rLNU的PRT中位数为182分钟（四分位数范围，155-230分钟）。后验的截止值，横向,前PFTs为15毫米，24毫米，和6毫米，分别。多变量分析显示后PFT≥15mm(比值比[OR]，2.72；95%置信区间，1.04-7.08；p=0.0410）是延长PRT的独立危险因素。
结论：后PFT厚是rLNU期间PRT延长的术前危险因素。对于UTUC和后PFT厚的患者，外科医生应该制定最佳的手术策略，包括选择专业外科医生作为主要外科医生，以及选择经腹膜手术或开放手术的方法。
方法：我们回顾了2013年至2021年间接受rLNU治疗UTUC的115例患者的数据。术前计算机断层扫描（CT）图像上观察到的肾周脂肪厚度（PFT）用于评估肾周脂肪量。采用logistic回归模型分析rLNU期间PRT的术前危险因素。基于中位时间确定PRT的截止值。根据受试者工作特征曲线分析确定影响PRT的脂肪相关因素的截止值。
结果：rLNU的PRT中位数为182分钟（四分位数范围，155-230分钟）。后验的截止值，横向,前PFTs为15毫米，24毫米，和6毫米，分别。多变量分析显示后PFT≥15mm(比值比[OR]，2.72；95%置信区间，1.04-7.08；p=0.0410）是延长PRT的独立危险因素。
结论：后PFT厚是rLNU期间PRT延长的术前危险因素。对于UTUC和后PFT厚的患者，外科医生应该制定最佳的手术策略，包括选择专业外科医生作为主要外科医生，以及选择经腹膜手术或开放手术的方法。
