甘弘成、馮思中、莊正鏗、張英勛、虞凱傑、林柏宏、劉忠一

Hung-Cheng Kan, See-Tong Pang, Cheng-Keng Chuang, Ying-Hsu Chang, Kai-Jie Yu, Po-Hung Lin, Chung-Yi Liu

Department of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University

 

Purpose:

Robotic partial nephrectomy is an increasingly performed, minimally invasive alternative to open partial nephrectomy. We compared early postoperative outcomes in 102 patients undergoing robotic and open partial nephrectomy.

Materials and Methods:

Data on 102 consecutive robotic or open partial nephrectomies were collected retrospectively from 2008 to 2014 in our centers. Demographic, intraoperative, postoperative and followup data were compared between the 2 groups.

Results:

Between the robotic (n=59) and open (n=43) partial nephrectomy groups significant differences were noted in ischemic time (31.86 vs 46.70 minutes, p <0.001 ), and preoperative glomerular filtration rate (92.8 vs 78.2 ml/minute/1.73 m2, P=0.004). Sex, surgical margin, blood loss, mean hospitalization days, complication rate, postoperative blood transfusion rate, recurrent rate and mortality rate were similar between the two groups. Preoperative glomerular filtration rate is the only risk factor of postoperative glomerular filtration rate declined at one year (p = 0.005). Patients in the robotic group with preoperative GFR< 74.49 ml/minute/1.73 m2 and open group preoperative GFR< 57.06 with ml/minute/1.73 m2 were far more likely (p <0.001) to have an estimated glomerular filtration rate less than 45 ml/minute/1.73 m2 after postoperative one year follow-up.

Conclusions:

Our results suggest that preoperative GFR was the most accurate predictor of actual postoperative renal function at one year. Although ischemia type and ischemia time were not associated with renal function at postoperative one year, open partial nephrectomy is more favorable than robotic partial nephrectomy in terms of patient with worse preoperative renal function.