Outcomes of Robot-assisted Partial Nephrectomy for Clinical T2 Renal Tumors: A Multicenter Analysis (ROSULA Collaborative Group)

被引：127

作者：

Bertolo, Riccardo ^{[1
,2
]}

Autorino, Riccardo ^{[3
]}

Simone, Giuseppe ^{[4
]}

Derweesh, Ithaar ^{[5
]}

Garisto, Juan D. ^{[2
]}

Minervini, Andrea ^{[6
]}

Eun, Daniel ^{[7
]}

Perdona, Sisto ^{[8
]}

Porter, James ^{[9
]}

Rha, Koon Ho ^{[10
]}

Mottrie, Alexander ^{[11
]}

White, Wesley M. ^{[12
]}

Schips, Luigi ^{[13
]}

Yang, Bo ^{[14
]}

Jacobsohn, Kenneth ^{[15
]}

Uzzo, Robert G. ^{[16
]}

Challacombe, Ben ^{[17
]}

Ferro, Matteo ^{[18
]}

Sulek, Jay ^{[19
]}

Capitanio, Umberto ^{[20
]}

Anele, Uzoma A. ^{[3
]}

Tuderti, Gabriele ^{[4
]}

Costantini, Manuela ^{[4
]}

Ryan, Stephen ^{[5
]}

Bindayi, Ahmet ^{[5
]}

Mari, Andrea ^{[6
]}

Carini, Marco ^{[6
]}

Keehn, Aryeh ^{[7
]}

Quarto, Giuseppe ^{[8
]}

Liao, Michael ^{[9
]}

Chang, Kidon ^{[21
]}

Larcher, Alessandro ^{[11
,20
]}

De Naeyer, Geert ^{[11
]}

De Cobelli, Ottavio ^{[18
]}

Berardinelli, Francesco ^{[13
]}

Zhang, Chao ^{[14
]}

Langenstroer, Peter ^{[15
]}

Kutikov, Alexander ^{[16
]}

Chen, David ^{[16
]}

De Luyk, Nicolo ^{[17
]}

Sundaram, Chandru P. ^{[19
]}

Montorsi, Francesco ^{[20
]}

Stein, Robert J. ^{[2
]}

Haber, Georges Pascal ^{[2
]}

Hampton, Lance J. ^{[3
]}

Dasgupta, Prokar ^{[17
]}

Gallucci, Michele ^{[4
]}

Kaouk, Jihad ^{[2
]}

Porpiglia, Francesco ^{[1
]}

机构：

[1] Univ Turin, San Luigi Gonzaga Hosp, Div Urol, Orbassano, Italy

[2] Cleveland Clin, Dept Urol, Cleveland, OH 44106 USA

[3] Virginia Commonwealth Univ Hlth Syst, Dept Surg, Div Urol, Richmond, VA USA

[4] Regina Elena Inst Canc Res, Dept Urol, Rome, Italy

[5] UCSD Hlth Syst, Dept Urol, La Jolla, CA USA

[6] Univ Florence, Dept Urol, Careggi Hosp, Florence, Italy

[7] Temple Univ, Dept Urol, Lewis Katz Sch Med, Philadelphia, PA 19122 USA

[8] IRCCS Fdn G Pascale, Div Urol, Naples, Italy

[9] Swedish Urol Grp, Seattle, WA USA

[10] Yonsei Univ, Coll Med, Urol Sci Inst, Seoul, South Korea

[11] Onze Lieve Vrouw Hosp, Dept Urol, Aalst, Belgium

[12] Univ Tennessee, Med Ctr, Dept Urol, Knoxville, TN USA

[13] Univ G dAnnunzio, Annunziata Hosp, Dept Urol, Chieti, Italy

[14] Changhai Hosp, Dept Urol, Shanghai, Peoples R China

[15] Med Coll Wisconsin, Dept Urol, Milwaukee, WA USA

[16] Fox Chase Canc Ctr, Div Urol Oncol, 7701 Burholme Ave, Philadelphia, PA 19111 USA

[17] Kings Coll London, Guys Hosp, NIHR Biomed Res Ctr, MRC Ctr Transplantat, London, England

[18] IEO, Dept Urol, Milan, Italy

[19] Indiana Univ, Dept Urol, Indianapolis, IN 46204 USA

[20] IRCCS Osped San Raffaele, URI, Div Expt Oncol, Unit Urol, Milan, Italy

[21] Yonsei Univ, Wonju Coll Med, Dept Urol, Wonju, South Korea

来源：

EUROPEAN UROLOGY | 2018年 / 74卷 / 02期

关键词：

Partial nephrectomy; Robot assisted; Renal neoplasm; Renal mass; Clinical T2; Outcomes; ACUTE KIDNEY INJURY; CELL CARCINOMA; RADICAL NEPHRECTOMY; ONCOLOGIC OUTCOMES; NEPHROMETRY SCORE; CENTER EXPERIENCE; CM; MASSES; T1B; MANAGEMENT;

D O I：

10.1016/j.eururo.2018.05.004

中图分类号：

R5 [内科学]; R69 [泌尿科学（泌尿生殖系疾病）];

学科分类号：

1002 ; 100201 ;

摘要：

Background: While partial nephrectomy (PN) represents the standard surgical management for cT1 renal masses, its role for cT2 tumors is controversial. Robot-assisted PN (RAPN) is being increasingly implemented worldwide. Objective: To analyze perioperative, functional, and oncological outcomes of RAPN for cT2 tumors. Design, setting, and participants: Retrospective analysis of a large multicenter, multinational dataset of patients with nonmetastatic cT2 masses treated with robotic surgery (ROSULA: RObotic SUrgery for LArge renal mass). Intervention: Robotic-assisted PN. Outcome measurements and statistical analysis: Patients' demographics, lesion characteristics, perioperative variables, renal functional data, pathology, and oncological data were analyzed. Univariable and multivariable regression analyses assessed the relationships with the risk of intra-/postoperative complications, recurrence, and survival. Results and limitations: A total of 298 patients were analyzed. Median tumor size was 7.6 (7-8.5) cm. Median RENAL score was 9 (8-10). Median ischemia time was 25 (2032) min. Median estimated blood loss was 150 (100-300) ml. Sixteen patients had intraoperative complications (5.4%), whereas 66 (22%) had postoperative complications (5% were Clavien grade >= 3). Multivariable analysis revealed that a lower RENAL score (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.21-0.65, p = 0.02) and pathological pT2 stage (OR 0.51, 95% CI 0.12-0.86, p = 0.001) were protective against postoperative complications. A total of 243 lesions (82%) were malignant. Twenty patients (8%) had positive surgical margins. Ten deaths and 25 recurrences/metastases occurred at a median follow-up of 12 (5-35) mo. At univariable analysis, higher pT stagewas predictive of a likelihood of recurrences/metastases (p = 0.048). While there was a significant deterioration of renal function at discharge, this remained stable over time at 1-yr follow-up. The main limitation of this study is its retrospective design. Conclusions: RAPN in the setting of select cT2 renal masses can safely be performed with acceptable outcomes. Further studies are warranted to corroborate our findings and to better define the role of robotic nephron sparing for this challenging indication. Patient summary: This report shows that robotic surgery can be used for safe removal of a large renal tumor in a minimally invasive fashion, maximizing preservation of renal function, and without compromising cancer control. Published by Elsevier B.V. on behalf of European Association of Urology.

引用

页码：226 / 232

页数：7

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