目的:肾肿瘤的肺门位置有时被视为安全肾部分切除术的限制因素。我们的目的是评估围手术期,肿瘤学,机器人辅助肾部分切除术(RAPN)与非肺门肿瘤(RAPN-NH)相比,肺门肿瘤(RAPN-H)的功能结局。
方法:我们进行了一项观察,使用法国肾癌研究网络(UroCCR)前瞻性收集的数据进行多中心队列研究。该注册表包括2010年至2023年在法国29家医院接受局部或局部晚期肾脏肿块RAPN的3551名患者的数据。我们研究了肺门位置对手术的影响,术后肾功能,肿瘤特征,和生存。我们还比较了三连冠成就率(热缺血时间[WIT]<25分钟,阴性手术切缘,两组之间没有围手术期并发症)。最后,我们进行了无血管夹闭的RAPN亚组分析.在单变量分析中比较变量,并使用多变量线性,logistic,和Cox比例风险模型调整相关患者和肿瘤协变量。
■分析人群包括3451名患者,其中2773人接受了RAPN-NH,678人接受了RAPN-H。更长的WIT(β=2.4分钟;p<0.01),肝门组手术时间较长(β=11.4min;p<0.01),术后并发症风险较高(比值比1.33;p=0.05)。失血,围手术期输血率,估计肾小球滤过率的术后变化,两组之间的Trifecta成就率具有可比性(p>0.05)。平均随访31.9个月,无复发生存率无显著差异(风险比[HR]0.82,95%置信区间[CI]0.58-1.2;p=0.3),癌症特异性生存率(HR1.1,95%CI0.48-2.6;p=0.79),或总生存期(HR0.89,95%CI0.52-1.53;p=0.69)。
结论:患者和肿瘤特征而不仅仅是肺门位置应该是肺门肿瘤最佳手术策略的主要决定因素。
结果:我们发现位于肾脏主要血管附近的肾脏肿瘤导致手术时间更长,并且在机器人辅助手术切除肿瘤期间发生并发症的风险更高。然而,这些部位的肿瘤与更高的肾功能丧失风险无关,癌症复发,或死亡。
OBJECTIVE: A hilar location for a renal tumour is sometimes viewed as a limiting factor for safe partial nephrectomy. Our aim was to evaluate perioperative, oncological, and functional outcomes of robot-assisted partial nephrectomy (RAPN) for hilar tumours (RAPN-H) in comparison to RAPN for nonhilar tumours (RAPN-NH).
METHODS: We conducted an observational, multicentre cohort study using prospectively collected data from the French Research Network on Kidney Cancer (UroCCR). The registry includes data for 3551 patients who underwent RAPN for localised or locally advanced renal masses between 2010 and 2023 in 29 hospitals in France. We studied the impact of a hilar location on surgery, postoperative renal function, tumour characteristics, and survival. We also compared rates of trifecta achievement (warm ischaemia time [WIT] <25 min, negative surgical margins, and no perioperative complications) between the groups. Finally, we performed a subgroup analysis of RAPN without vascular clamping. Variables were compared in univariable analysis and using multivariable linear, logistic, and Cox proportional-hazards models adjusted for relevant patient and tumour covariates.
UNASSIGNED: The analytical population included 3451 patients, of whom 2773 underwent RAPN-NH and 678 underwent RAPN-H. Longer WIT (β = 2.4 min; p < 0.01), longer operative time (β = 11.4 min; p < 0.01) and a higher risk of postoperative complications (odds ratio 1.33; p = 0.05) were observed in the hilar group. Blood loss, the perioperative transfusion rate, postoperative changes in the estimated glomerular filtration rate, and trifecta achievement rates were comparable between the groups (p > 0.05). At mean follow-up of 31.9 mo, there was no significant difference in recurrence-free survival (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.58-1.2; p = 0.3), cancer-specific survival (HR 1.1, 95% CI 0.48-2.6; p = 0.79), or overall survival (HR 0.89, 95% CI 0.52-1.53; p = 0.69).
CONCLUSIONS: Patient and tumour characteristics rather than just hilar location should be the main determinants of the optimal surgical strategy for hilar tumours.
RESULTS: We found that kidney tumours located close to major kidney blood vessels led to a longer operation and a higher risk of complications during robot-assisted surgery to remove the tumour. However, tumours in these locations were not related to a higher risk of kidney function loss, cancer recurrence, or death.