針對大型腎臟腫瘤(≥7公分)比較經後腹腔機械手臂輔助與腹腔鏡腎臟部分切除術後之結果：單一醫學中心縱貫性研究

蔡易辰¹、謝佳駤¹、曾文歆^1,2、劉建良³、李健逢⁴、黃冠華¹、邱文祥⁵

台南永康奇美醫院 外科部 泌尿科¹；國立中山大學生物醫學研究所²；台南永康奇美醫院 外科部 泌尿腫瘤科³，台南永康奇美醫院 病理部⁴；台北馬偕醫院 泌尿科⁵

Comparison of Retroperitoneal Robotic-assisted and Laparoscopic Partial Nephrectomy for Large Renal Tumors (≥7cm)：A Single-Center Longitudinal Study

I-Chen Tsai¹、Chia-Chih Hsieh¹、Wen-Hsin Tseng^1,2、Chien-Liang Liu³、Chien-Feng Li⁴、Steven K. Huang¹、Allen W.Chiu⁵

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

² Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan;

³Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

⁴Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan;

⁵Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan

Purpose: Partial nephrectomy (PN) is one of the surgical treatment options for renal tumors. In selective patients, large renal tumors (≥7cm) can be resected under robotic-assisted partial nephrectomy (RAPN) or laparoscopic partial nephrectomy (LPN). Therefore, we reported our experiences and compared the surgical outcomes between two different operation techniques for large renal tumors of ≥7cm.

Materials and Methods: We assessed 39 patients who had renal tumors ≥7cm and underwent either retroperitoneal RAPN or LPN in our medical center between 2015 and 2021 retrospectively. We excluded 1 patient received bilateral nephron-sparing surgery in the same procedure. The tumor characteristics were obtained from computed tomography and defined by the RENAL Nephrometry Score. Perioperative outcomes between two groups were compared using the chi-squared and Student’s t-tests.

Results: Of the 38 patients in this study, 25 (65.8%) had RAPN and the other 13 (34.2%) had LPN. On comparing the tumor characteristics and surgical outcomes, we found that the total RENAL score was significantly higher (9.5 vs. 8.1, p = 0.013) in the RAPN group. Comparing the score of the nearness of collecting system (N), the RAPN group was also significantly higher (2.85 vs. 2, p = 0.005). Upper pole tumor was also significantly more (61% vs. 20%, p = 0.013) in RAPN group. However, the estimated blood loss showed significantly higher in the RAPN group (670.9 mL vs. 343.3 mL, p = 0.009). The operation time was shorter in the RAPN group than LPN group, but the difference was not significantly difference between the two groups (111.5 min vs. 146.7 min, p = 0.054). Though the renal tumors were significantly much more complex in the RAPN group, the decrease in renal function at post-operative day 1 (-6.4% vs. -11.9%, p = 0.419) and at post-operative year 1 (-5.9% vs. -8.4%, p = 0.642) were not significant. All patients received retroperitoneal approach surgery, and no post-operative gastrointestinal-related complications were reported in both groups.