目的:肾癌手术经常在日本的小型地区医院进行。这项研究评估了肾癌手术的结果,将机器人手术前的结果与机器人手术获得的结果进行比较。
方法:这项前瞻性队列研究是对2008年至2013年间在14家医院接受肾癌手术的患者进行的。由13家地区医院和一所大学医院组成,在东北泌尿外科循证医学研究组注册。患者背景;围手术期数据;年度术后肾功能;和预后调查,获得了中位随访10年的结果.
结果:在14家注册医院的930例手术病例中,cT1a的10年无复发生存率,cT1b,cT2和cT3分别为0.9326、0.8501、0.5786和0.5101。同时,10年总生存率分别为0.9612,0.8662,0.7505和0.7209.cT1患者的长期观察显示,血管受累和高肿瘤分级是复发的预后因素。作为一个值得注意的事实,53.3%的cT1a患者在地区医院进行了根治性肾切除术。然而,即使在术前慢性肾脏病3期患者中,根治性肾切除术也不是肾功能的预后因素.这表明代偿机制在许多接受根治性肾切除术而没有高血压和术前蛋白尿的患者中已经工作了很长时间。是终末期肾病的预测因子。
结论:基于对前机器人时代的前瞻性长期调查,我们的结果表明,大学医院和地区医院的生存结局没有差异.我们的研究提供了基线数据来评估肾癌机器人手术的结果,在地区医院进行。
OBJECTIVE: Renal cancer surgery is frequently performed in small regional hospitals in Japan. This study evaluated the outcomes of renal cancer surgery, comparing results from the pre-robotic surgery era with those obtained with robotic surgery.
METHODS: This prospective cohort study was conducted on patients who underwent renal cancer surgery between 2008 and 2013 at 14 hospitals, comprising 13 regional hospitals and a university hospital, registered in the Tohoku Urological Evidence-Based Medicine Study Group. The patients\' backgrounds; perioperative data; annual postoperative renal function; and prognostic surveys, performed over a median follow-up period of 10 years were obtained.
RESULTS: In 930 surgical cases at the 14 registered hospitals, the 10-year recurrence-free survival rates of cT1a, cT1b, cT2, and cT3 were 0.9326, 0.8501, 0.5786, and 0.5101, respectively. Meanwhile, the 10-year overall survival rates were 0.9612, 0.8662, 0.7505, and 0.7209, respectively. Long-term observation in patients with cT1 showed that vessel involvement and high tumor grade were prognostic factors for recurrence. As a noteworthy fact, radical nephrectomy was performed in 53.3% of patients with cT1a at the regional hospitals. However, even in patients with preoperative chronic kidney disease stage 3, radical nephrectomy was not a prognostic factor of renal function. This indicates that compensatory mechanisms had been working for a long time in many patients who underwent radical nephrectomies without hypertension and preoperative proteinuria, which were predictors of end-stage renal disease.
CONCLUSIONS: Based on a prospective long-term survey of the pre-robotic era, our results suggested no difference of the survival outcomes between the university hospital and regional hospitals. Our study provides baseline data to evaluate the outcomes of renal cancer robotic surgery, performed at regional hospitals.