da Vinci robot-assisted laparoscopic partial nephrectomy for renal tumors with PADUA score ≥10 / 第二军医大学学报

ABSTRACT

Objective: To evaluate the safety, feasibility and efficacy of da Vinci robot-assisted laparoscopic partial nephrectomy in treating renal tumors with PADUA score ≥10, so as to discuss its clinical potential. Methods: Between May 2012 and September 2013, da Vinci robot-assisted laparoscopic partial nephrectomy was performed for 37 renal tumors with PADUA score ≥10 by a single urologist in our institution. The information of the patients were age 52.3±10.1(32-72) years old; body mass index 24.9±3.88(17.1-34.3) kg/m2; Charlson Co-morbidity Index (Age-weighted) 0.5±0.84(0-3); and tumor laterality (L/R) 20/17. The tumors were unilateral and solitary lesions, with a mean diameter of 4.2±1.19(2.1-7.2) cm, a PADUA score of 10.8±0.87(10-13), and a preoperative estimated glomerular filtration rate (eGFR) of 101.2±25.58 (46.6-198.7) mL/(min·1.73 m2). The renal arteries veins, and renal surroundings were isolated and the tumors were excised with or without blocking renal pedicle; all these procedures together with renorrhaphy were done by da Vinci robot-assisted laparoscopic techniques. Results: All the 37 cases were smoothly done without surgical conversion, intraoperative complications or transfusion. The mean operative time was 241±50.0 (120-330) min, estimated blood loss was 185±169.9(50-1 000) mL, and renal ischemia time was 26.7±9.90(0-50) min. The mean postoperative hospital stay was 11.4±3.44(8-19) days, with an overall complication rate of 13.5%(5/37). Pathological examination revealed no positive surgical margin, and there were 28 cases of renal clear cell carcinoma, 3 papillary cell carcinoma, and 5 different types of benign lesions. All the patients were alive during a mean follow-up of 5.9±4.64(1-12) months, with no local recurrence or distant metastasis. Nevertheless, eGFR was decreased by a mean of 8%, showing significant difference compared with that before operation(Z=-2.883, P=0.004). Conclusion: For high PADUA score renal tumors, da Vinci robot-assisted laparoscopic partial nephrectomy has the advantages of minimal invasiveness, better safety, fine manipulation, and renal function preservation, although the cancer control outcome awaits further follow-up.