Background: Renal tumors in solitary kidneys require treatments that optimize both oncological and functional outcomes. Robot-assisted partial nephrectomy (RAPN) offers a balance between these needs and reduced morbidity. This study investigates the oncologic and functional outcomes of RAPN in solitary-kidney patients.Methods: We analyzed data from 1852 patients with cT1-T4N0M0 renal cell carcinoma treated by RAPN from January 2018 to June 2022. The cohort included patients with solitary kidneys based on preoperative characteristics, tumor staging and perioperative outcomes using the Trifecta criteria.Results: Of the study participants, 39 had solitary kidneys. Fifteen patients (38.6%) had an ASA score > 2, indicating a higher preoperative risk. The median PADUA score was 7 (IQR 8–9). Moreover, 28 (71.8%) patients had a chronic kidney disease stage > 2. Trifecta success was achieved in 26 (66.6%) of the cases. During a median follow-up of 36 months, tumor recurrence was observed in 12 patients (30.7%), with local recurrences in 4 (10.2%) and systemic recurrences in 8 (20.5%). A higher ASA score and global ischemic clamping were independent predictors of renal function decline at the third postoperative day and Trifecta failure. Only a higher ASA score significantly predicted a significant long-term decline in renal function. Nucleolar grade at pathological stage was the only factor significantly associated with tumor recurrence.Conclusions: RAPN is as an effective treatment for renal tumors in solitary kidneys, balancing oncological control and renal function preservation. Global ischemia and patient physical status are the most important factors influencing outcomes and highlight the importance of patient selection and tailored surgical strategies.
背景：孤立肾肾肿瘤的治疗需兼顾肿瘤学与功能学双重预后。机器人辅助肾部分切除术（RAPN）在实现这一平衡的同时降低了手术相关并发症。本研究旨在探讨RAPN对孤立肾患者的肿瘤学及功能学结局。 方法：我们分析了2018年1月至2022年6月期间接受RAPN治疗的1852例cT1-T4N0M0肾细胞癌患者数据。根据术前特征、肿瘤分期及围手术期结局，采用Trifecta标准筛选出孤立肾患者纳入研究队列。 结果：研究队列中39例为孤立肾患者。15例（38.6%）患者ASA评分>2分，提示术前风险较高。中位PADUA评分为7分（四分位距8-9分）。28例（71.8%）患者慢性肾脏病分期>2期。26例（66.6%）达到Trifecta复合标准。中位随访36个月期间，12例（30.7%）出现肿瘤复发，其中局部复发4例（10.2%），全身性复发8例（20.5%）。较高ASA评分及全肾缺血夹闭是术后第三天肾功能下降和Trifecta失败的独立预测因素。仅有较高ASA评分能显著预测长期肾功能显著下降。病理分期核仁分级是唯一与肿瘤复发显著相关的因素。 结论：RAPN是治疗孤立肾肾肿瘤的有效方法，能平衡肿瘤控制与肾功能保护。全肾缺血状态及患者身体状况是影响预后的关键因素，凸显了患者选择和个体化手术策略的重要性。
肿瘤(癌症)患者之家