台北榮民總醫院 泌尿部;1 國立陽明大學醫學院 泌尿學科2
Robotic-assisted partial nephrectomy for hilar and non-hilar tumors: perioperative ouctomes
Shih-Yen Lu1, Hsiao-Jen Chung1, 2, Yi-Hsiu Huang1, 2, Tzu-Ping Lin1, 2,
Alex T.L. Lin1, 2, Kuang-Kuo Chen1, 2
Department of Urology, Taipei Veterans general hospital1 Department of Urology, School of medicine, National Yang-Ming university, Taipei, Taiwan2
The aim of this study was to compare the perioperative outcome between hilar tumors and non-hilar tumors after robotic-assisted partial nephrectomy (RAPN).
Materials and Methods:
A retrospective review of 160 patients who underwent RAPN for a solitary renal tumor from December 2009 to September 2014 at our institution was performed. A total 163 tumors received consecutive RAPN were recruited. Demographic data and perioperative outcomes were compared between the hilar tumor group (n=25) and non-hilar tumor group (n=137). One hilar tumor case was converted to open method due to grossly vessel invasion and was excluded for analysis.
In demographic data, there was no difference between age, gender and American Society of Anethesiologists (ASA) physical status score. Hilar tumor group had less BMI (23.5 vs 25.4, p= 0.022) and had larger preoperative maximal tumor size (4.9cm vs 3.6 cm, p<0.001). Hilar tumor group had higher PADUA score (10.7 vs 8.4, p<0.001) and higher RENAL score (8.9 vs 7.2, p<0.001). The rate of renal cell carcinoma (RCC) was 52% at hilar group and 70.1% at non-hilar group (p=0.07).
Surgeries for hilar tumor were associated with longer operative time (292 vs 239 minutes, p=0.005), greater console time (220 vs 176 minutes, p=0.016) and longer warm ischemia time (40 vs 22 minutes, p<0.001). There was no statistically different in estimated blood loss (EBL), transfusion rate, postoperative stay and complication rate.
When comparing peri-operative renal function, non-hilar had a significant declined of serum creatinine (p<0.0001) and estimated GFR (p<0.0001) at post-operative 6 months and 12 months. Hilar tumor had a significant declined of serum creatinine at post-operative 12 months (p=0.042). Both hilar and non-hilar tumor had a significant declined of effective renal plasma flow (ERPF) ratio at post-op 6 months (p= hilar/non-hilar: 0.0054/<0.0001) and 12 months (p= hilar/non-hilar: 0.006/<0.0001).
Hilar tumors received RAPN seems not be associated with an increased EBL, transfusion rate and postoperative stay and complication rate. RAPN is a safe and effective nephron-sparing surgery technique for hilar tumors.