背景:肾部分切除术是处理小肾肿块的首选治疗选择。钳夹式肾部分切除术与缺血风险和术后肾功能丧失有关,而非钳夹手术减少了肾缺血的持续时间,导致更好的肾功能保存。然而,非钳夹式肾部分切除术与非钳夹式肾部分切除术保留肾功能的疗效尚有争议.
目的:比较下夹机器人辅助肾部分切除术(RAPN)的围手术期和功能结局。
方法:本研究使用前瞻性跨国合作的Vattikuti集体质量倡议(VCQI)数据库进行RPN。
方法:本研究的主要目的是比较接受结夹和结夹RAPN的患者的围手术期和功能结局。计算年龄的倾向得分,性别,体重指数(BMI),肾脏计评分(RNS)和术前估计的肾小球滤过率(eGFR)。
结论:在2114名患者中,210人接受了非钳夹RAPN和其他钳夹手术。205例患者的倾向匹配比例为1:1。匹配后,两组的年龄相当,性别,BMI,肿瘤大小,多焦点,肿瘤侧,面对肿瘤,RNS,肿瘤的极性位置,手术通路,术前血红蛋白,肌酐,和eGFR。术中两组之间没有差异(4.8%vs5.3%,p=0.823)和术后(11.2%vs8.3%,p=0.318)并发症。需要输血(2.9%vs0,p=0.030)和转换为根治性肾切除术(10.2%vs1%,p<0.001)在非钳夹组中明显更高。在最后一次随访中,两组肌酐和eGFR无差异。最后一次随访时与基线时相比,两组的eGFR平均下降相当(-16.0vs-17.3ml/min,p=0.985)。
结论:Off-clusionsRAPN不会导致更好的肾功能保护。或者,这可能与根治性肾切除术的转换率增加以及输血需求相关.
结果:通过这项多中心研究,我们注意到,在不阻断肾脏血液供应的情况下进行机器人肾部分切除术与更好的肾功能保护无关.然而,非钳夹肾部分切除术与根治性肾切除术和输血的转换率增加相关。
BACKGROUND: Partial nephrectomy is the preferred treatment option for the management of small renal masses. On-clamp partial nephrectomy is associated with a risk of ischemia and a greater loss of postoperative renal function, while the off-clamp procedure decreases the duration of renal ischemia, leading to better renal function preservation. However, the efficacy of the off- versus on-clamp partial nephrectomy for renal function preservation remains debatable.
OBJECTIVE: To compare perioperative and functional outcomes following off- and on-clamp robot-assisted partial nephrectomy (RAPN).
METHODS: This study used the prospective multinational collaborative Vattikuti Collective Quality Initiative (VCQI) database for RAPN.
METHODS: The primary objective of this study was the comparison of perioperative and functional outcomes between patients who underwent off- and on-clamp RAPN. Propensity scores were calculated for age, sex, body mass index (BMI), renal nephrometry score (RNS) and preoperative estimated glomerular filtration rate (eGFR).
CONCLUSIONS: Of the 2114 patients, 210 had undergone off-clamp RAPN and others on-clamp procedure. Propensity matching was possible for 205 patients in a 1:1 ratio. After matching, the two groups were comparable for age, sex, BMI, tumor size, multifocality, tumor side, face of tumor, RNS, polar location of the tumor, surgical access, and preoperative hemoglobin, creatinine, and eGFR. There was no difference between the two groups for intraoperative (4.8% vs 5.3%, p = 0.823) and postoperative (11.2% vs 8.3%, p = 0.318) complications. Need for blood transfusion (2.9% vs 0, p = 0.030) and conversion to radical nephrectomy (10.2% vs 1%, p < 0.001) were significantly higher in the off-clamp group. At the last follow-up, there was no difference between the two groups for creatinine and eGFR. The mean fall in eGFR at the last follow-up compared with that at baseline was equivalent between the two groups (-16.0 vs -17.3 ml/min, p = 0.985).
CONCLUSIONS: Off-clamp RAPN does not result in better renal functional preservation. Alternatively, it may be associated with increased rates of conversion to radical nephrectomy and need for blood transfusion.
RESULTS: With this multicentric study, we noted that performing robotic partial nephrectomy without clamping the blood supply to the kidney is not associated with better preservation of renal function. However, off-clamp partial nephrectomy is associated with increased rates of conversion to radical nephrectomy and blood transfusion.