UNASSIGNED:目前的文献没有提供关于机器人辅助(RAPN)与开放(OPN)肾部分切除术的临床结果的大规模数据。此外,评估RPN后长期肿瘤结局预测因素的数据很少.
未经批准:比较围手术期,功能,和肿瘤结果的RAPN与OPN,并探讨肿瘤治疗后预后的预测因素。
UNASSIGNED:本研究纳入了2004年至2018年间接受OPN(n=1063)或RAPN(n=2404)单一cT1-2N0M0肾脏肿块治疗的3467例患者,其中9例欧洲,北美,亚洲机构。
未经评估:研究结果为术后短期,功能,和肿瘤结果。回归模型调查了手术入路(开放与机器人辅助)对研究结果的影响,和相互作用检验用于亚组分析。在敏感性分析中使用人口统计学和肿瘤特征的倾向评分匹配。多变量Cox回归分析确定了RPN后肿瘤预后的预测因子。
UNASSIGNED:接受RAPN和OPN的患者的基线特征相似,只有很少的差异。在调整混杂因素后,RPN与术中(比值比[OR]:0.39,95%置信区间[CI]:0.22,0.68)和Clavien-Dindo术后≥2(OR:0.29,95%CI:0.16,0.50)并发症的几率较低(均p<0.05)。这个协会没有受到合并症的影响,肿瘤尺寸,PADUA得分,或术前肾功能(相互作用试验均p>0.05)。在多变量分析中,我们发现两种技术在功能和肿瘤结局方面没有差异(均p>0.05).总的来说,有63和92局部复发和全身进展,分别,手术后的中位随访时间为32mo(四分位距:18,60)。在接受RAPN的患者中,我们以辨别的准确性评估了局部复发和全身进展的预测因素(即,C指数)范围从0.73到0.81。
未经证实:虽然癌症控制和长期肾功能在RAPN和OPN之间没有差异,我们发现,术中和术后的发病率,特别是在并发症方面,在RPN后低于OPN后.我们的预测模型允许外科医生估计RPN后不良肿瘤学结果的风险,对术前咨询和术后随访具有相关意义。
UNASSIGNED:在这项关于机器人和开放性肾部分切除术的比较研究中,两种技术的功能和肿瘤结局相似,具有较低的发病率-尤其是在并发症方面-用于机器人辅助手术。对接受机器人辅助肾部分切除术患者的预后评估可能有助于术前咨询,并提供相关数据以调整术后随访。
UNASSIGNED: Current literature does not provide large-scale data regarding clinical outcomes of robot-assisted (RAPN) versus open (OPN) partial nephrectomy. Moreover, data assessing predictors of long-term oncologic outcomes after RAPN are scarce.
UNASSIGNED: To compare perioperative, functional, and oncologic outcomes of RAPN versus OPN, and to investigate the predictors of oncologic outcomes after RAPN.
UNASSIGNED: This study included 3467 patients treated with OPN (n = 1063) or RAPN (n = 2404) for a single cT1-2N0M0 renal mass from 2004 to 2018 at nine high-volume European, North American, and Asian institutions.
UNASSIGNED: The study outcomes were short-term postoperative, functional, and oncologic outcomes. Regression models investigated the effect of surgical approach (open vs Robot assisted) on study outcomes, and interaction tests were used for subgroup analyses. Propensity score matching for demographic and tumor characteristics was used in sensitivity analyses. Multivariable Cox-regression analyses identified predictors of oncologic outcomes after RAPN.
UNASSIGNED: Baseline characteristics were similar between patients receiving RAPN and OPN, with only few differences. After adjusting for confounding, RAPN was associated with lower odds of intraoperative (odds ratio [OR]: 0.39, 95% confidence interval [CI]: 0.22, 0.68) and Clavien-Dindo ≥2 postoperative (OR: 0.29, 95% CI: 0.16, 0.50) complications (both p < 0.05). This association was not affected by comorbidities, tumor dimension, PADUA score, or preoperative renal function (all p > 0.05 on interaction tests). On multivariable analyses, we found no differences between the two techniques with respect to functional and oncologic outcomes (all p > 0.05). Overall, there were 63 and 92 local recurrences and systemic progressions, respectively, with a median follow-up after surgery of 32 mo (interquartile range: 18, 60). Among patients receiving RAPN, we assessed predictors of local recurrence and systemic progression with discrimination accuracy (ie, C-index) that ranged from 0.73 to 0.81.
UNASSIGNED: While cancer control and long-term renal function did not differ between RAPN and OPN, we found that the intra- and postoperative morbidity-especially in terms of complications-was lower after RAPN than after OPN. Our predictive models allow surgeons to estimate the risk of adverse oncologic outcomes after RAPN, with relevant implications for preoperative counseling and follow-up after surgery.
UNASSIGNED: In this comparative study on robotic versus open partial nephrectomy, functional and oncologic outcomes were similar between the two techniques, with lower morbidity-especially in terms of complications-for robot-assisted surgery. The assessment of prognosticators for patients receiving robot-assisted partial nephrectomy may help in preoperative counseling and provides relevant data to tailor postoperative follow-up.