機器手臂輔助部分腎切除手術在腎門腫瘤與非腎門腫瘤之
手術前後結果比較
呂仕彥1、鍾孝仁1,2、黃逸修1,2、林子平1,2、林登龍1,2、陳光國1,2
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
Purpose:
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.
Results:
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).
Conclusions:
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.