比較前後側腎臟腫瘤以腹膜外腎臟部分切除術後之早期結果：單一醫學中心五年經驗

謝佳駤¹、曾文歆¹、劉建良²，蘇家震¹、李健逢³、黃冠華¹、邱文祥⁴

台南永康奇美醫院 外科部 泌尿科¹，泌尿腫瘤科²，病理部³；台北馬偕醫院 泌尿科⁴

Early Postoperative Outcomes of Retroperitoneal Partial Nephrectomy of Anterior and Posterior Renal Tumors: A Five-Year Experience in a Single Center

Chia-Chih Hsieh¹、Wen-Hsin Tseng¹、Chien-Liang Liu^1,2、Chia-Cheng Su¹、Chien-Feng Li³、Steven K. Huang¹、Allen W.Chiu⁴

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

²Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

³Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan

⁴Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan

Purpose: Partial nephrectomy (PN) is one of the surgical treatment options for renal tumors. In recent years, many studies have compared transperitoneal PN outcomes for anterior and posterior renal tumors. Therefore, the aim of this study was to compare the surgical outcomes of retroperitoneal PN for anterior and posterior tumors.

Materials and Methods: This study enrolled 191 patients who had renal tumors that were detected on abdominal computed tomography (CT) and who underwent either laparoscopic or robotic PN, between January 2017 and September 2021. Tumor complexity was defined by the RENAL Nephrometry Score. Surgical outcomes were compared between approaches using the chi-squared and Student’s t-tests.

Results: In this study, a total of 103 (53.9%) patients had anterior renal tumors and 88 (47.1%) had posterior renal tumors. On comparing the surgical results between the two groups, we found that the total RENAL score was significantly higher (7.5 vs. 6.8, p = 0.014) in the anterior group. The anterior group also had higher levels of hemoglobin reduction (-1.92 vs. -1.54, p = 0.032), but the estimated blood loss showed no significantly difference between the two groups (355.6 mL vs. 309.8 mL, p = 0.458). The operation time for the anterior group was relatively longer than the posterior group, but the difference was not significant (196.6 min vs. 177.9 min, p = 0.06). In addition, the decrease in eGFR on post-operative day 1 ( -1.7% vs. -1.2%, p=0.641) and at post-operative months 6–12 ( -3.71% vs. -3.1%, p = 0.737) was not significantly difference between the two groups. Other surgical outcomes, such as blood transfusion rate (p = 0.888), positive surgical margin (p = 0.782), complications (p = 0.467), and lengths of stay (p = 0.764), were also not significantly different between the two groups. No post-operative gastrointestinal-related complications were reported in both groups.

Conclusions: This study demonstrated retroperitoneal surgical access to renal tumors and revealed equivalent surgical outcomes for both anterior and posterior renal tumors. Retroperitoneal PN can be considered a good approach for both anterior and posterior renal tumors with few intraabdominal complications.