Introduction:Available guidelines recommend performing nephron-sparing surgery in selected renal cell carcinoma (RCC) patients. Many studies provided robot-assisted partial nephrectomy (RAPN) functional and oncological outcomes, with most of these including a wide timespan and a number of surgeons with different experiences, which might lead to the heterogeneity of the results. In this study, we aim to provide a contemporary report of RAPN patient outcomes performed at two referral centers by experienced surgeons.Materials and Methods:Overall, 333 RAPN patients treated at two European referral centers between 2019 and 2021 were identified. Continuous and categorical variables were reported using medians and proportions. Multi-variable logistic regression (MLR) models were fitted to test predictors of off-clamp technique use and trifecta achievement.Results: The median age was 65 (IQR: 57–73) years. The clinical stage distribution was as follows: 224 (67%) cT1a vs. 89 (26%) cT1b vs. 20 cT2 (7%). The median warm ischemia time was 14 (10–18) minutes, with trifecta being achieved in 74% (n = 240) of patients. In MLR models predicting off-clamp surgery, an increasing R.E.N.A.L. score was independently associated with a lower chance of attempting such a technique (OR: 0.69,p-value < 0.001). In models predicting trifecta achievement, both a higher R.E.N.A.L. score (OR: 0.78,p-value = 0.007) and the presence of multiple lesions (OR: 0.29,p-value = 0.007) were independently associated with lower chances of reaching the outcome. Significant upstaging of chronic kidney disease (CKD) stage was recorded in 9.4% of patients after one year of follow-up.Conclusions: We reported the contemporary outcomes of patients treated with RAPN by highly experienced surgeons from two referral centers. This report represents a valid benchmark that could be used for individual patient counseling in the decision-making process.
引言：现有指南建议对特定肾细胞癌患者实施保留肾单位手术。多项研究已报道机器人辅助肾部分切除术的功能与肿瘤学结果，但多数研究涵盖时间跨度广且涉及经验各异的外科医生，可能导致结果异质性。本研究旨在由经验丰富的外科医生在两个转诊中心开展机器人辅助肾部分切除术，提供当代患者结局报告。 材料与方法：共纳入2019年至2021年间在欧洲两个转诊中心接受机器人辅助肾部分切除术的333例患者。连续变量和分类变量分别以中位数和比例形式呈现。采用多变量逻辑回归模型分析无阻断技术使用及三联征达成的预测因素。 结果：患者中位年龄为65岁（四分位距：57-73岁）。临床分期分布如下：cT1a期224例（67%），cT1b期89例（26%），cT2期20例（7%）。中位热缺血时间为14分钟（10-18分钟），74%的患者（n=240）实现三联征。在预测无阻断手术的多变量逻辑回归模型中，R.E.N.A.L.评分升高与尝试该技术可能性降低独立相关（比值比：0.69，p值<0.001）。在预测三联征达成的模型中，较高的R.E.N.A.L.评分（比值比：0.78，p值=0.007）和多发病灶（比值比：0.29，p值=0.007）均与实现该结局的可能性降低独立相关。随访一年后，9.4%的患者出现慢性肾病分期显著升级。 结论：本研究报道了两个转诊中心由经验丰富的外科医生实施机器人辅助肾部分切除术的当代患者结局。该报告为决策过程中的个体化患者咨询提供了有效的基准参考。
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