Background and Objectives: Totally endophytic renal tumors are a unique subset that pose significant technical challenges during partial nephrectomy (PN). The aim of this study was to evaluate the perioperative, oncologic, and functional outcomes of PN in this particular setting. Materials and Methods: We retrospectively evaluated 4151 patients who had surgical treatment for renal tumors between January 2013 and December 2016 at 26 urological Italian Centers (RECORD 2 project). Only patients treated with PN for entirely endophytic renal tumor were considered for final analyses. Results: A total of 211 patients were included, with a median PADUA score of 10 (IQR 9-11). Open, laparoscopic, and robotic approaches were used in 94 (44.5%), 52 (24.6%), and 65 (30.8%) cases, respectively. While surgical approach did not impact complication rates, robotic PN had significantly lower median blood loss (100 vs. 185 vs. 175 cc,p= 0.04) and shorter operative time (126 vs. 140 vs. 160 min,p= 0.01) compared to open and laparoscopic PN. At a median follow-up of 36.3 months (IQR 21.9–49.2), recurrence-free survival was 93.8%. Median %eGFR drop at 24 months was 12.1 (IQR 5.1–21.9), with significant eGFR loss (≥25%) in 36 (17.1%) patients. The robotic approach was associated with a lower %eGFR drop at 1-month and 1-year evaluations, but the benefit diminished at 24 months. Multivariate analysis showed age and open surgery as independent predictors of renal function loss at 1 month and Trifecta failure. Conclusions: The conservative management of entirely endophytic renal tumors is associated with favorable functional and oncologic outcomes. Whenever technically feasible, conservative surgery should be prioritized to optimize early renal function recovery.
背景与目的：完全内生性肾肿瘤是一类独特的亚型，在肾部分切除术（PN）中带来显著的技术挑战。本研究旨在评估此类特定情况下PN的围手术期、肿瘤学及功能学结果。材料与方法：我们回顾性分析了2013年1月至2016年12月期间在意大利26家泌尿外科中心（RECORD 2项目）接受肾肿瘤手术治疗的4151例患者。最终分析仅纳入因完全内生性肾肿瘤接受PN治疗的患者。结果：共纳入211例患者，中位PADUA评分为10分（四分位距9-11）。开放、腹腔镜及机器人手术分别应用于94例（44.5%）、52例（24.6%）和65例（30.8%）。虽然手术方式不影响并发症发生率，但机器人PN的中位失血量显著更低（100 vs. 185 vs. 175毫升，p=0.04），手术时间更短（126 vs. 140 vs. 160分钟，p=0.01）。中位随访36.3个月（四分位距21.9-49.2）后，无复发生存率为93.8%。24个月时中位估算肾小球滤过率（eGFR）下降百分比为12.1%（四分位距5.1-21.9），其中36例（17.1%）患者出现显著eGFR下降（≥25%）。机器人手术在1个月和1年评估时与较低的eGFR下降百分比相关，但该优势在24个月时减弱。多变量分析显示年龄和开放手术是1个月时肾功能丧失及Trifecta复合终点失败的独立预测因素。结论：完全内生性肾肿瘤的保守治疗可获得良好的功能与肿瘤学结局。在技术可行的情况下，应优先选择保留肾单位手术以优化早期肾功能恢复。
肿瘤(癌症)患者之家