針對大於4公分之腎細胞癌使用機器手臂輔助部分腎切除手術治療:
單一醫學中心經驗
張英傑、王又德、吳錫金、張兆祥、楊啟瑞、黃志平*
中國醫藥大學附設醫院 泌尿部
Robotic partial nephrectomy for > 4cm renal cell carcinoma: single center experience
Ying-Chieh Chang, Yu-De Wang, Hsi-Chin Wu, Chao-Hsiang Chang, Chi-Rei Yang, Chi-Ping Huang*
Department of Urology, China Medical University Hospital, Taichung, Taiwan
Purpose:
Robot partial nephrectomy represents a widely accepted minimally invasive alternative to open and laparoscopic surgery for the treatment of clinically localized renal tumors. We want to understand the technical feasibility, renal functional and oncologic outcomes with robot laparoscopic partial nephrectomy for renal cell carcinoma greater than 4 cm.
Materials and Methods:
Between January 2011 and December 2018, 49 patients with tumor size > 4cm underwent partial nephrectomy in our institution, and 23 patients were enrolled (undergo robotic partial nephrectomy). We analyzed the patient demographic information including patient age (IQR), male gender (%) , body mass index (BMI), ASA classification , Charlson comorbidity index (CCI) and the perioperative outcome including operative time, ischemia time, estimated blood Loss(EBL), the length of stay, complication, pathological features and survival rate with SPSS 20.
Results:
Of the 23 patients, the clinical outcomes were as below: median operation time: 274.5 minutes, median ischemic time: 27.5 minutes, median hospital stay: 8 days, pathological cell types (clear cell : papillary : chromophobe = 69.6% : 9.1% : 17.4%), Fuhrman grade(I-II: 87% , III-IV: 13%), recurrence rate:4.3%, and 5-year survival rate 91.3%.
Conclusion:
Robotic partial nephrectomy is a safe and feasible approach for RCC of size > 4cm. Robotic assistance may facilitate tumor resection and renal reconstruction, which offering minimally invasive approach an adequate option for nephron sparing surgery.