Introduction:In minimally invasive, off-clamp partial nephrectomy (ocMIPN), the reconstructive strategy profoundly influences functional outcomes. Traditional nephrometry scores aid preoperative planning but do not directly inform the choice of closure technique. This dual-institutional study aimed primarily to identify preoperative CT-derived parameters predictive of renorrhaphy versus a sutureless approach, and secondarily to compare perioperative and functional outcomes between these techniques.Methods:We retrospectively analyzed 201 consecutive ocMIPN cases performed using a standardized off-clamp technique by two experienced surgical teams across robotic platforms and conventional laparoscopy. Preoperative CT scans were centrally reviewed to quantify morphometric features, including contact surface area (CSA), tumor radius, and Gerota’s fascia thickness. Univariable and multivariable logistic regression models—one restricted to radiologic variables and one expanded with RENAL score terms—were generated to identify independent predictors. Perioperative outcomes, renal functional metrics, and Trifecta rates were compared between cohorts.Results:Among the 201 patients, 101 (50.2%) underwent sutureless reconstruction and 100 (49.8%) renorrhaphy. Cohorts were comparable at baseline except for tumor size (3.1 vs. 3.6 cm;p= 0.04). In multivariable analysis, CSA > 15 cm2(OR 3.93; 95% CI 1.26–12.26;p= 0.02) and tumor radius (OR 1.14 per mm; 95% CI 1.01–1.29;p= 0.04) consistently predicted renorrhaphy, while Gerota’s fascia < 10 mm emerged as significant only in the expanded specification (OR 0.08; 95% CI 0.01–0.70;p= 0.02). Integration with RENAL improved predictive performance (ΔAUC 0.06; NRI 0.14; IDI 0.07), and the final model demonstrated strong discrimination (AUC 0.81) with satisfactory calibration. Perioperative outcomes, postoperative renal function, and Trifecta achievement were similar between groups (allp≥ 0.21).Conclusions:A concise set of CT-derived morphologic markers—CSA, tumor radius, and perinephric fascia thickness—anticipated reconstructive strategy in ocMIPN and augmented the discriminatory power of RENAL nephrometry. When anatomy was favorable, sutureless repair was not associated with statistically significant differences in perioperative safety or renal function, although the study was not powered for formal equivalence testing. These findings support the integration of radiologic markers into preoperative planning frameworks for nephron-sparing surgery.
引言：在微创免阻断肾部分切除术（ocMIPN）中，重建策略对功能预后具有深远影响。传统肾测量评分有助于术前规划，但无法直接指导闭合技术的选择。这项双中心研究的主要目的是确定术前CT衍生参数，以预测缝合修复与免缝合技术的选择；次要目的是比较这两种技术的围手术期及功能预后。 方法：我们回顾性分析了由两个经验丰富的外科团队在机器人平台和传统腹腔镜下采用标准化免阻断技术连续完成的201例ocMIPN病例。术前CT扫描经中心化审阅，以量化形态学特征，包括接触表面积（CSA）、肿瘤半径和肾周筋膜厚度。我们构建了单变量和多变量逻辑回归模型（一个模型仅纳入放射学变量，另一个模型扩展纳入RENAL评分项）以识别独立预测因子。比较了两组间的围手术期结果、肾功能指标及Trifecta达成率。 结果：在201例患者中，101例（50.2%）接受了免缝合重建，100例（49.8%）接受了缝合修复。除肿瘤大小（3.1 cm vs. 3.6 cm；p=0.04）外，两组基线特征具有可比性。多变量分析显示，CSA > 15 cm²（OR 3.93；95% CI 1.26–12.26；p=0.02）和肿瘤半径（每毫米OR 1.14；95% CI 1.01–1.29；p=0.04）始终是缝合修复的预测因子，而肾周筋膜厚度 < 10 mm仅在扩展模型中显示为显著预测因子（OR 0.08；95% CI 0.01–0.70；p=0.02）。与RENAL评分整合后，模型预测性能得到提升（ΔAUC 0.06；NRI 0.14；IDI 0.07），最终模型显示出较强的区分度（AUC 0.81）和良好的校准度。两组在围手术期结果、术后肾功能及Trifecta达成率方面均相似（所有p值≥0.21）。 结论：一组简明的CT衍生形态学标志物——CSA、肿瘤半径和肾周筋膜厚度——可预测ocMIPN的重建策略选择，并增强了RENAL肾测量评分的区分能力。在解剖条件有利时，免缝合修复并未在围手术期安全性或肾功能方面表现出统计学显著差异，尽管本研究未进行正式的等效性检验。这些发现支持将放射学标志物整合到肾单位保留手术的术前规划框架中。
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