Comparison of Robot-Assisted Laparoscopic Partial Nephrectomy with Laparoscopic Cryoablation in the Treatment of Localised Renal Tumours: A Propensity Score-Matched Comparison of Long-Term Outcomes
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Preoperative Assessment and Perioperative Data
2.3. Statistical Analyses
2.4. Surgical Techniques: RaPN
2.5. Surgical Techniques: LCA
3. Results
3.1. Perioperative Data and Pathological Outcome
3.2. Oncological Outcomes
3.3. Renal Function Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | RaPN | LCA | p-Value | |
---|---|---|---|---|
Case number, n | 55 | 55 | ||
Gender, % (n) | >0.99 | |||
Males | 52.7% (29) | 52.7% (29) | ||
Females | 47.3% (26) | 47.3% (26) | ||
Systemic diseases, % (n) | ||||
CAD | 5.5% (3) | 5.5% (3) | >0.99 | |
HTN | 40.0% (22) | 45.5% (25) | 0.563 | |
DM | 20.0% (11) | 18.2% (10) | 0.808 | |
CKD | 18.2% (10) | 23.6% (13) | 0.482 | |
Other malignancy | 16.4% (9) | 14.5% (8) | 0.792 | |
Mean age, years | 57.27 ± 13.28 | 59.44 ± 14.77 | 0.616 | |
ASA score, % (n) | 0.644 | |||
1 | 0% (0) | 0% (0) | ||
2 | 76.4% (42) | 80.0% (44) | ||
3 | 23.6% (13) | 20.0% (11) | ||
4 | 0% (0) | 0% (0) | ||
Mean BMI, kg/m2 | 25.29 ± 4.58 | 25.04 ± 4.23 | 0.245 | |
Anesthesia, % (n) | - | |||
LA | 0% (0) | 0% (0) | ||
GA | 100% (55) | 100% (55) | ||
Tumor size, cm | 4.06 ± 2.01 | 3.86 ± 2.13 | 0.796 | |
Clinical T stage, % (n) | ||||
T1a | 60.0% (33) | 58.2% (32) | 0.846 | |
T1b | 36.4 % (20) | 40.0% (22) | 0.695 | |
T2a | 0 % (0) | 0% (0) | - | |
T2b | 3.6% (2) | 1.8% (1) | >0.99 | |
Tumor side, % (n) | >0.99 | |||
Left | 45.5% (25) | 45.5% (25) | ||
Right | 54.5% (30) | 54.5% (30) |
Characteristic | RaPN (n = 55) | LCA (n = 55) | p-Value | |
---|---|---|---|---|
Follow-up, month | 33.20 ± 19.55 | 54.96 ± 34.59 | <0.001 * | |
Approach, % (n) | ||||
Transperitoneal | 43.6% (24) | 3.6% (2) | <0.001 * | |
Retroperitoneal | 56.4% (31) | 96.4% (53) | ||
Probe of cryoablation, n | - | 2.54 ± 1.28 | - | |
Robotic arms, n | 3.30 ± 0.46 | - | - | |
Operative time, min | 267.45 ± 104.53 | 138.56 ± 45.28 | <0.001 * | |
Warm ischemia time, min | 23.70 ± 16.58 | - | - | |
Console time, min | 165.96 ± 70.35 | - | - | |
LOS, day | 6.11 ± 5.10 | 4.15 ± 2.71 | 0.239 | |
Estimated blood loss, mL | 300.56 ± 360.73 | 30.73 ± 50.31 | <0.001 * | |
Preoperative Hb, g/dL | 13.38 ± 1.71 | 13.22 ± 1.89 | 0.314 | |
Change of Hb, g/dL | −1.59 ± 1.27 | −1.11 ± 1.18 | 0.466 | |
Preoperative Hct, % | 40.32 ± 4.41 | 36.69 ± 5.34 | 0.272 | |
Change of Hct, % | −5.10 ± 3.79 | −3.67 ± 3.44 | 0.234 | |
Intra-operative complication, % (n) | ||||
Open conversion | 3.6% (2) | 0% (0) | 0.495 | |
Bowel injury | 1.8% (1) | 0% (0) | >0.99 | |
Post-operative complication, % (n) | ||||
Blood transfusion | 23.6% (13) | 14.5% (8) | 0.225 | |
Fever | 21.8% (12) | 5.5% (3) | 0.012 * | |
Subcutaneous emphysema | 0% (0) | 1.8% (1) | >0.99 | |
Pneumothorax | 0% (0) | 1.8% (1) | >0.99 | |
Hemorrhage need intervention | 0% (0) | 1.8% (1) | >0.99 | |
Complications, % (n) | ||||
Minor, Clavien 1–2 | 0% (0) | 5.5% (3) | 0.243 | |
Major, Clavien 3–5 | 3.6% (2) | 3.6% (2) | >0.99 |
Characteristic | RaPN (n = 55) | LCA (n = 55) | p-Value | |
---|---|---|---|---|
RCC histology, % (n) | 58.2% (32) | 49.1% (27) | 0.339 | |
Clear cell RCC, % (n) | 45.5% (25) | 32.7% (18) | 0.171 | |
Papillary RCC, % (n) | 0% (0) | 1.8% (1) | >0.99 | |
Chromophobe RCC, % (n) | 9.1% (5) | 1.8% (1) | 0.206 | |
MiT Family translocation RCC, % (n) | 1.8% (1) | 0% (0) | >0.99 | |
Mixed epithelial and stromal tumor, % (n) | 0% (0) | 0% (0) | - | |
Unclassified, % (n) | 1.8% (1) | 12.7% (7) | 0.06 | |
Benign conditions, % (n) | 41.8% (23) | 49.1% (27) | 0.444 | |
Oncocytoma, % (n) | 3.6% (2) | 5.5% (3) | >0.99 | |
AML, % (n) | 32.7% (18) | 16.4% (9) | 0.046 * | |
Cyst, % (n) | 3.6% (2) | 1.8% (1) | >0.99 | |
Inconclusive or Negative for malignancy, % (n) | 0% (0) | 20.0% (11) | <0.001 * |
Characteristic | RaPN (n = 23) | LCA (n = 15) | p-Value |
---|---|---|---|
Positive surgical margins, % (n) | 0% (0) | - | - |
Local recurrence, % (n) | 0% (0) | 0% (0) | - |
Metastasis, % (n) | 0% (0) | 0% (0) | - |
De novo tumor, % (n) | 0% (0) | 0% (0) | - |
Characteristic | RaPN (n = 9) | LCA (n = 12) | p-Value |
---|---|---|---|
Positive surgical margins, % (n) | 11.1% (1) | - | - |
Local recurrence, % (n) | 0% (0) | 16.7% (2) | 0.486 |
Metastasis, % (n) | 11.1% (1) | 0% (0) | 0.429 |
De novo tumour, % (n) | 11.1% (1) | 0% (0) | 0.429 |
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Liu, H.-Y.; Kang, C.-H.; Wang, H.-J.; Chen, C.-H.; Luo, H.-L.; Chen, Y.-T.; Cheng, Y.-T.; Chiang, P.-H. Comparison of Robot-Assisted Laparoscopic Partial Nephrectomy with Laparoscopic Cryoablation in the Treatment of Localised Renal Tumours: A Propensity Score-Matched Comparison of Long-Term Outcomes. Diagnostics 2021, 11, 759. https://doi.org/10.3390/diagnostics11050759
Liu H-Y, Kang C-H, Wang H-J, Chen C-H, Luo H-L, Chen Y-T, Cheng Y-T, Chiang P-H. Comparison of Robot-Assisted Laparoscopic Partial Nephrectomy with Laparoscopic Cryoablation in the Treatment of Localised Renal Tumours: A Propensity Score-Matched Comparison of Long-Term Outcomes. Diagnostics. 2021; 11(5):759. https://doi.org/10.3390/diagnostics11050759
Chicago/Turabian StyleLiu, Hui-Ying, Chih-Hsiung Kang, Hung-Jen Wang, Chien-Hsu Chen, Hao-Lun Luo, Yen-Ta Chen, Yuan-Tso Cheng, and Po-Hui Chiang. 2021. "Comparison of Robot-Assisted Laparoscopic Partial Nephrectomy with Laparoscopic Cryoablation in the Treatment of Localised Renal Tumours: A Propensity Score-Matched Comparison of Long-Term Outcomes" Diagnostics 11, no. 5: 759. https://doi.org/10.3390/diagnostics11050759