使用機械手臂輔助之部分腎臟切除與腹腔鏡冷凍消融術治療局限性腎臟腫瘤的比較
劉惠瑛、康智雄、王弘仁、陳建旭、羅浩倫、李維菁、
陳彥達、鄭元佐、江博暉、吳彥廷
高雄長庚紀念醫院 泌尿科
Comparisons of robot-assisted partial nephrectomy and laparoscopic cryoablation for the treatment of localized renal tumor
Hui-Ying Liu, Chih-Hsiung Kang, Hong-Ren Wang, Chien-Hsu Chen, Hao-Lun Luo, Wei-Ching Lee, Yen-Ta Chen, Yuan-Tso Cheng, Po-Hui Chiang, Yen-Ting Wu
Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Purpose
To preserve renal function and control oncological outcomes are pertinent while managing renal neoplasms. In the current evidence, cryoablation is only suggested in clinical T1a stage renal tumor. We compared outcomes of robot-assisted partial nephrectomy (RaPN) and laparoscopic cryoablation (LCA) for the treatment of patient with localized T1-T2 renal tumor.
Methods
We identified 108 patients with renal tumors in our hospital, where 60 patients received RaPN and 68 patients underwent LCA from July 2008 to October 2018, and they were followed up until January 2019. We compared preoperative and postoperative parameters, gender, systemic diseases, age, American Society of Anesthesiologists score (ASA score), body mass index (BMI), tumor size, clinical tumor stage, nephrometry scores, operative time, estimated blood loss amount, change of hemoglobin and hematocrit, the estimated glomerular filtration rate, tumor type, Clavien–Dindo classification of surgical complications, tumor recurrence, and overall survival rate, by using an independent sample t test, Pearson’s Chi-square test, Fisher’s exact test, generalized linear model, and Kaplan-Meier method.
Results
In our hospital, we started cryoablation earlier than da Vinci Robotic assisted surgery, therefore the follow-up period is longer in the LCA group than RaPN group. Based on baseline characteristics, the two groups had similar comorbidities, BMI, age, tumor size, clinical tumor stage, and nephrometry scores. The two groups also shared similar length of stay, intra-operative complications, minor or major complications either in tumor ≤ 4cm or > 4cm, oncological outcome, and overall survival rate. We found that the patients in the LCA group had shorter operative time, less estimated blood loss, less change of hemoglobin and hematocrit, and less postoperative fever episodes than those in the RaPN group. No patient experienced deterioration in renal function until 3 years in the RaPN group and 5 years in the LCA group.
Conclusions
Our results indicated that LCA method has comparable intraoperative, postoperative, and oncological outcomes to RaPN method in localized T1-T2 renal tumor. The LCA group had the advantages of less operative time and blood loss due to relative less invasive procedure. Further research is needed to confirm this novel finding.