比較cT1與cT2腎臟腫瘤以腹膜外腎臟部分切除術後之腎功能預後

林仁傑¹、謝佳駤²、曾文歆^2,4、劉建良³、黃冠華²、邱文祥⁵

台南永康奇美醫院 一般科¹；台南永康奇美醫院 外科部 泌尿科²，泌尿腫瘤科³；國立中山大學生物醫學研究所⁴；台北新光吳火獅紀念醫院 泌尿科⁵

Comparison of Functional Outcome Between cT1 and cT2 Renal Tumor After Retroperitoneal Laparoscopic Partial Nephrectomy

Ren-Jie Lin¹、Chia-Chih Hsieh²、Wen-Hsin Tseng^2,4、Chien-Liang Liu³、Steven K. Huang²、Allen W.Chiu⁵

¹Postgraduate Year, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;
²Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;
³Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

⁴Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan;

⁵Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.

Purpose:

Partial nephrectomy (PN) has been the main strategy for treating cT1 (≤7cm) renal tumors. Previous studies have established PN's safety and effectiveness over radical nephrectomy (RN) for cT1 tumors, with comparable results between transabdominal and retroperitoneal approaches. However, the efficacy and safety of retroperitoneal PN for larger renal tumors (>7cm) remained controversial. Here, we conducted a retrospective analysis to compare the functional, perioperative, and oncological outcome of cT1 and cT2 tumors undergoing retroperitoneal laparoscopic PN.

Materials and Methods:

From January 2017 to April 2021, we collected data from 201 patients undergoing retroperitoneal laparoscopic PN. Of these, 173 (86.1%) had tumors ≤7cm (cT1, Group A) and 28 (13.9%) had tumors >7cm (cT2, Group B). We analyzed demographics (gender, age, BMI, Charlson Comorbidity Index, preoperative hemoglobin and renal function, tumor location, operative method, RENAL score), perioperative (operative time, warm ischemic time, estimated blood loss, hospital stay, surgical margins, complications), and functional outcomes (changes in renal function pre- and postoperatively), along with recurrence rates.

Results:

Mean tumor sizes in groups A and B were 3.67±1.56 cm and 9.90±2.97 cm, respectively. RENAL score analysis revealed a significant difference (7.64 vs. 9.21, P<0.001), attributed solely to the Radius parameter. Group B had significantly higher estimated blood loss (567 ml vs. 317 ml, p=0.004) and complication rates (10.71% vs. 2.89%, p=0.049), with no gastrointestinal complications reported. Regarding functional outcomes, only the reduction in postoperative eGFR on day 1 (POD1) was significant (-0.74 vs -8.31, p=0.016), with no significant differences at 3 months (POM3), 6 months (POM6), or 1 year (POY1) postoperatively (-3.92 vs -8.55, p=0.07; -2.01 vs -5.53, p=0.18; and -2.99 vs -6.68, p=0.15, respectively).

Conclusion:

Retroperitoneal PN for cT2 tumors achieves perioperative outcomes and preserves renal function as effectively as for cT1 tumors according to this study. It is a viable approach for larger renal tumors with minimal intraabdominal complications.