Background/Objectives: Three-dimensional (3D) image-guided robotic-assisted partial nephrectomy (3D-IGRAPN) integrates patient-specific anatomical models to optimize surgical planning and intraoperative guidance in the management of renal tumors. This study aimed to assess medium-term functional and oncologic outcomes of 3D-IGRAPN in a large, prospective cohort. Methods: All consecutive patients undergoing 3D-IGRAPN between January 2016 and March 2023 at a tertiary referral center were prospectively included in the UroCCR database (NCT03293563). Patient-specific 3D models were generated from preoperative CT scans and used intraoperatively. The primary endpoint was trifecta achievement, defined as an absence of major complications (Clavien–Dindo ≥ 3), negative surgical margins for malignant tumors, and ≥90% preservation of baseline renal function at 3 months. Secondary endpoints included functional outcomes, complication rates, local recurrence, and metastasis rates, as well as cancer-specific and overall survivals. Results: Among 568 patients (586 surgeries), the trifecta was achieved in 55.2% of evaluable malignant cases. Severe complications occurred in 33 cases (5.6%), and positive surgical margins were reported in 27 cases (5.1%) out of 528 surgeries involving malignant lesions. Renal function was preserved in 59.9% of patients at 3 months. At a mean follow-up of 31.5 months, recurrence and metastasis rates were 7.4% and 8.6%, respectively. Cancer-specific and overall survival at follow-up were 96.5% and 89%. Conclusions: 3D-IGRAPN demonstrates favorable functional and oncologic outcomes, even in complex tumors. These results support the integration of 3D modeling as a standard tool in image-guided nephron-sparing surgery.
**背景/目的：** 三维图像引导机器人辅助肾部分切除术通过整合患者特异性解剖模型，优化肾肿瘤治疗中的手术规划和术中引导。本研究旨在评估一项大型前瞻性队列中3D-IGRAPN的中期功能和肿瘤学结果。 **方法：** 2016年1月至2023年3月期间，在一家三级转诊中心连续接受3D-IGRAPN的所有患者均前瞻性纳入UroCCR数据库。患者特异性3D模型基于术前CT扫描生成并用于术中。主要终点是"三联征"达成率，定义为无主要并发症、恶性肿瘤切缘阴性以及术后3个月时基线肾功能保留率≥90%。次要终点包括功能结果、并发症发生率、局部复发和转移率，以及癌症特异性生存率和总生存率。 **结果：** 在568名患者（586例手术）中，可评估的恶性病例中"三联征"达成率为55.2%。发生严重并发症33例（5.6%）；在528例涉及恶性病灶的手术中，报告切缘阳性27例（5.1%）。术后3个月时，59.9%的患者肾功能得以保留。在平均31.5个月的随访中，复发率和转移率分别为7.4%和8.6%。随访期间的癌症特异性生存率和总生存率分别为96.5%和89%。 **结论：** 3D-IGRAPN显示出良好的功能和肿瘤学结果，即使在复杂肿瘤中也是如此。这些结果支持将3D建模作为图像引导肾单位保留手术的标准工具进行整合。
肿瘤(癌症)患者之家