比較臨床良性與惡性腎臟腫瘤接受微創部分腎臟切除手術
之手術與腎功能之短期預後
麥倖嘉1、吳俊賢1,3、陳忠賢1,3、吳振宇1,3、李彥羲2,3、林嘉祥1,3
義大醫院泌尿科；1義大癌治療醫院泌尿科，2義守大學國際醫學系,3
Comparison of the Surgical and Functional Outcomes for
Clinically Benign versus Malignant Renal Tumor after Minimally Invasive Partial Nephrectomy
Hsing-Chia Mai 1, Chun-Hsien Wu 1,3, Chung-Hsien Chen 1,3,
Richard Chen-Yu Wu 1,3 Yen-His Lee 2,3, Victor C. Lin 1,3
1Department of Urology, E-DA Hospital, Kaohsiung, Taiwan
2 Department of Urology, E-DA cancer Hospital, Kaohsiung, Taiwan
3School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan
Purpose: Partial nephrectomy (PN) is the standard management for clinical T1a malignant renal tumors. In certain situations, PN is also a treatment option of clinical T1b malignant renal tumors for better renal function preservation. Furthermore, a benign renal tumor more than 4 cm or symptomatic benign renal tumor can be managed by PN. However, PN has higher surgical morbidities compared with radical nephrectomy. Laparoscopic PN (LPN) is a technically dependent surgery which can achieve comparable outcomes as open PN in experienced hands. Nowadays, robotic-assisted PN (RAPN) is gaining popularity due to a better surgical ergonomics. Whether the pre-operative diagnosis has any effect on perioperative and renal functional outcomes after minimally invasive PN (i.e., LPN and RAPN) has never been discussed before. Herein, we aim to conduct an outcome analysis for clinically benign tumor(cBT) and malignant tumor (cMT) post minimal invasive PN.
Methods: We retrospectively analyzed patients with a renal mass who underwent minimal invasive PN by a single dedicated surgical team between 2008 and 2017. Tumor complexity was quantified by RENAL (Radius, Exophytic/endophytic, Nearness of tumor to collecting system or sinus, Anterior/posterior, Location relative to polar lines) nephrometry score. Perioperative and functional outcomes were compared between patients with cBT and cMT. Numerical data was compared by Mann-Whitney U test, while categorical data by Chi-square test. The Predictors of eGFR change were calculate by a multiple linear regression model
Results: Of 80 enrolled patients, sixty-four (80%) underwent LPN and 16 (20%) underwent RAPN. Twenty-six patients had cBT, and another 54 had cMT.
There was no significant difference between cBT and cMT in RENAL score (8.1 vs 7.7, p=0.368), Body mass index (BMI), (24.9 vs 26.0, p=0.274), and Charlson comorbidity index ( 3.2 vs 3.6, p=0.393) but longer warm ischemic time (WIT) (29.5 min vs 43.2 min, p=<0.01), and longer hospital stay in cMT patient but not reach statistical significance (7.0 vs 8.9 days, p=0.185). There was no significant difference in decline estimated glomerular filtration rate (eGFR) in two group after six months follow up (cBT: -8.6 vs cMT: -11.6 ml/min per 1.73m2, p=0.153) but significant difference in decline eGFR after subgroup analysis at high RENAL score category (cBT: -5.6 vs cMT: -14.9 ml/min per 1.73m2, p=0.037). Besides there were no significant predictors for postoperative eGFR change after multiple liner regression analysis.
Conclusions: The pre-operation diagnosis on renal tumor not influence the renal function outcome, seems the parenchymal loss for surgical margin in malignancy renal tumor resection is small in minimally invasive PN. But significant deterioration of renal function was noted at High RENAL score category after six months follow up. In our study, there were no significant predictor for renal function preservation, but require more study and case number to verify our findings.