機器人手臂輔助腎臟部分切除手術治療腎腫瘤：單一外科醫師經驗的五重結果

王柏仁^1,2、歐宴泉³、黃立華³、呂謹亨³、翁瑋駿³、楊晨洸⁴、許兆畬³、林益聖³

、張祐剛³、童敏哲³

¹國軍台中總醫院 外科部 泌尿科 ²國防醫學院 醫學系

³童綜合醫院 外科部 泌尿科 ⁴台中榮民總醫院 外科部 泌尿科

Robotic partial nephrectomy for renal tumor: The pentafecta outcomes of a single surgeon experience

Bo-Ren Wang^1,2 、Yen-Chuan Ou³、Li-Hua Huang³、Chin-Heng Lu³、Wei-Chun Weng³、

Cheng-Kuang Yang⁴、Chao-Yu Hsu³、Yi-Sheng Lin³、Yu-Kang Chang³、Min-Che Tung³

¹Division of Urology, Department of Surgery, Taichung Armed Forces General Hospital

²National Defense Medical Center,

³Divisions of Urology, Department of Surgery, Tungs' Taichung Metro Harbor Hospital

⁴Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital

Purpose: This study investigated the oncological and functional surgical outcomes for patients with renal tumor who underwent robot-assisted partial nephrectomy (PN) by a single surgeon in Taiwan from 2006 to 2019.

Materials and Methods: This retrospective study assessed patients who underwent robot-assisted PN for renal tumor. Patient data were analyzed for age, sex, body mass index, operative time and total ischemic time, surgical margin (positive/negative), and surgical complications. To evaluate functional and oncological outcomes, achievement of trifecta, and pentafecta criteria was used. Trifecta criteria were defined as a negative surgical margin, no postoperative complications, warm ischemia time <25 min. Pentafecta criteria were the trifecta criteria, >90% preservation of estimated glomerular filtration rate (eGFR) preservation, and no stage progression of chronic kidney disease at 1-year follow-up.

Results: Of 101 patients who received robot-assisted PN, the most common type of renal tumor was clear cell renal cell carcinoma (RCC) (38%), followed by angiomyolipoma (26%). Patient characteristics were mean age 54.59 ± 13.8 years; mean RENAL Nephrometry score 6.63 ± 2.16; mean operative time 102.34 ± 50.06 min; and warm ischemia time 20.01 ± 14.12 min. The mean eGFR was 104.43 ± 31.73 mL/min/1.73 m2 preoperatively and 89.39 ± 32.3 mL/min/1.73 m2 postoperatively. Pathologic evaluation showed malignant tumors in 57 patients, among whom achievement of trifecta criteria occurred for 39 (68.42%) and pentafecta criteria for 18 (31.57%). Operation time was the only predictor for pentafecta achievement.

Conclusion:

Robotic PN is a safe and effective approach for patients with renal tumor that can preserve

most renal function and achieve oncological control. Pentafecta criteria can be used to define the surgical outcome of RAPN more clearly.