Introduction: In recent years, due to the increasing life expectancy and the growing popularity of nephron sparing strategies (NSS), more elderly and frail patients are undergoing Robotic-Assisted Partial Nephrectomy (RAPN) for the treatment of localized Renal Cell Carcinoma (RCC). A Single Port Approach has demonstrated itself to reduce estimated blood loss (EBL), complication rates, and length of stay (LOS). In the present study, we aim to compare perioperative and postoperative outcomes of SP RAPN and Multi Port (MP) RAPN, with a focus on elderly patients. Materials and Methods: In the study, 293 cN0M0 RCC patients who underwent MP and SP RAPN performed at our institution from 2018 to 2024 were retrospectively reviewed. Clinical, demographic, patient, and tumor characteristics and perioperative variables were assessed across group A (<65 years old) and group B (≥65 years old) patients, as well as MP and SP cohorts. Subsequently, univariate and multivariate regression analyses were carried out, particularly for elderly patients, to evaluate the impact of selected preoperative and perioperative variables on the risk of 30-day postoperative complications. Results: Clinical and demographic characteristics were similar across the MP and SP cohorts of group A and group B. The SP cohort of both group A and group B demonstrated significantly higher rates of extraperitoneal access (75.9% vs. 26.6% for group A,p< 0.001 and 81.8% vs. 26.2% for group B,p< 0.001), shorter median operative times (186 [142.8–222] min vs. 190 [153–238] min for group A,p< 0.001 and 173.5 [143–228] min vs. 206 [178–237] min for group B,p< 0.001), and shorter median LOS (0 [0–1] days vs. 2 [1–3] days for group A,p< 0.001 and 0 [0,1] days vs. 2 [2–4] days for group B,p< 0.001). Moreover, for both groups, an SP approach required significantly longer median ischemia times (21 min [18–31] vs. 20 min [16–24] for group A,p= 0.02 and 24.5 min [20–28] vs. 19.5 min [16–26] for group B,p= 0.03). However, the SP cohort of group B, despite the lower rate of on-clamp procedures (63.4% vs. 90.5%,p= 0.03), demonstrated significantly lower median EBL (50 mL [31–142] vs. 100 mL [50–200],p= 0.03). At multivariate analysis, the SP approach was an independent predictor of lower 30-day postoperative complications (OR: 0.2, 95%CI 0.04–0.9,p= 0.04). Conclusions: In the present study, elderly patients undergoing SP RAPN did not demonstrate higher complication rates, EBL or hospitalization days compared to their younger counterparts. Moreover, an SP approach was found protective for 30-day postoperative complications. Our results suggest that SP RAPN is feasible and safe in older and frailer patients.
引言：近年来，随着预期寿命的延长和保留肾单位策略的日益普及，越来越多的老年及体弱患者接受机器人辅助肾部分切除术治疗局限性肾细胞癌。单孔入路已被证实能够减少估计失血量、降低并发症发生率并缩短住院时间。本研究旨在比较单孔与多孔机器人辅助肾部分切除术的围手术期及术后结果，并重点关注老年患者群体。 材料与方法：本研究回顾性分析了2018年至2024年间在本机构接受多孔及单孔机器人辅助肾部分切除术的293例cN0M0肾细胞癌患者。对A组（<65岁）与B组（≥65岁）患者，以及多孔与单孔队列的临床、人口统计学、患者与肿瘤特征及围手术期变量进行评估。随后针对老年患者进行单因素及多因素回归分析，以评估特定术前及围手术期变量对术后30天并发症风险的影响。 结果：在A组与B组中，多孔与单孔队列的临床及人口统计学特征基本相似。A组与B组的单孔队列均显示出显著更高的腹膜外入路比例（A组：75.9% vs. 26.6%，p<0.001；B组：81.8% vs. 26.2%，p<0.001）、更短的中位手术时间（A组：186[142.8–222]分钟 vs. 190[153–238]分钟，p<0.001；B组：173.5[143–228]分钟 vs. 206[178–237]分钟，p<0.001）以及更短的中位住院时间（A组：0[0–1]天 vs. 2[1–3]天，p<0.001；B组：0[0,1]天 vs. 2[2–4]天，p<0.001）。此外，两组单孔入路均需显著更长的中位缺血时间（A组：21分钟[18–31] vs. 20分钟[16–24]，p=0.02；B组：24.5分钟[20–28] vs. 19.5分钟[16–26]，p=0.03）。然而，B组单孔队列尽管术中阻断率较低（63.4% vs. 90.5%，p=0.03），其中位估计失血量显著更低（50毫升[31–142] vs. 100毫升[50–200]，p=0.03）。多因素分析显示，单孔入路是降低术后30天并发症的独立预测因素（比值比：0.2，95%置信区间0.04–0.9，p=0.04）。 结论：本研究中，接受单孔机器人辅助肾部分切除术的老年患者相较于年轻患者，并未表现出更高的并发症发生率、估计失血量或住院天数。此外，单孔入路对术后30天并发症具有保护作用。我们的研究结果表明，单孔机器人辅助肾部分切除术对于老年及体弱患者是可行且安全的。
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