演題抄録

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開催概要
開催回
第56回・2018年・横浜
 

腹腔鏡下およびロボット支援下腎部分切除術におけるtrifecta、pentafecta達成率の検討

演題番号 : P33-6

[筆頭演者]
演者)松本 隆児:1 
[共同演者]
古御堂 純:1、宮田 遥:1、菊地 央:1、大澤 崇宏:1、丸山 覚:1、安部 崇重:1、篠原 信雄:1

1:北海道大学・泌尿器科

 

Background
Since May 2016, we introduced robot-assisted partial nephrectomy (RAPN) for cT1 renal tumor, and all the four surgeons with previous experiences of pure laparoscopic partial nephrectomy started RAPN. The objective of this study was to compare perioperative outcomes based on trifecta and pentafecta rates in patients who underwent RAPN and laparoscopic partial nephrectomy (LPN), and assess whether the introduction of RAPN had been safely achieved.
Patients and Methods
Patients undergoing RAPN and LPN at our hospital between January 2015 and March 2018 were included. Background factors and perioperative data were retrospectively collected from our clinical database or medical charts and statistically analyzed. Pentafecta was defined as achievement of trifecta (negative surgical margin, no postoperative complications, and warm ischemia time less than 25 minutes) plus 1. ≧90% estimated glomerular filtration rate preservation, and 2. no chronic kidney disease upstage 6 months after surgery.
Result
Overall, 32 patients undergoing RAPN performed by four surgeons and 32 patients undergoing LPN performed by four surgeons were included in the present analysis. Regarding preoperative characteristics, there were no significant differences in age, sex, body mass index, tumor size, and renal nephrometry score between the two groups. In terms of perioperative outcomes, there were no significant differences in operation time (RAPN: median 168 min., LPN: median 194 min., p = 0.053), warm ischemia time (RAPN: median 19 min., LPN: median 22 min., p = 0.358), surgical margin positive rate (RAPN: 3.1%, LPN: 3.1%, p = 0.754), and Clavien-Dindo Grade 2/3-complication rate (RAPN: 0%, LPN: 9.3%, p = 0.119). The rate of achievement of Trifecta was 90.1% for RAPN vs. 68.8% for LPN (p = 0.034), while that of Pentafecta was 52.0% vs. 34.4% (p = 0.143).
Conclusions
RAPN was safely introduced in our hospital. RAPN was superior to LPN with regard to the achievement of trifecta outcomes.

キーワード

臓器別:腎・尿路・膀胱

手法別:手術療法

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