演題抄録

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開催概要
開催回
第56回・2018年・横浜
 

ロボット支援腹腔鏡下腎部分切除術におけるTrifecta・Pentafectaの達成率に関する検討

演題番号 : P33-7

[筆頭演者]
演者)高田 剛:1 
[共同演者]
木下 竜弥:1、古賀 実:1、菅尾 英木:1

1:箕面市立病院・泌尿器科

 

Objectives: To investigate the safety and feasibility of Robot-assisted partial nephrectomy (RAPN) on small renal mass by assessment of trifecta and pentafecta rate in our initial experience.
Materials and methods: We retrospectively analyzed prospectively collected data of 11 patients undergoing RAPN from Augast 2016 to April 2018. Demographic and perioperative data were collected and statistically analyzed. Pentafecta is defined as achievement of trifecta (negative surgical margins, no postoperative complications, and warm ischemia time <=25 minutes) with the addition of two other variables, namely, over 90% estimated glomerular filtration rate (eGFR) preservation, and no chronic kidney disease stage progression 1 year after surgery. Predicted postoperative rGFR was calculated by multiplying preoperative eGFR by the percent of total kidney tissue preserved after RAPN, using Vincent® analyze system.
Results: The median warm ischemia time was median 25 min (13-31). Positive surgical margin rate was 0%. Postoperative complication (Clavien Dindo >=3) rate was 18.2%. Over 90% eGFR preservation rate was 81.8%. No patient had chronic kidney disease stage progression after surgery. The rate of achievement of trifecta and pentafecta were 54.5%, 45.5% respectively. For achievement of pentafecta, R.E.N.A.L nephrometry score (HR 0.80; 95% CI (0.67-0.97); p = 0.031) was significant predictor of achieving pentafecta. Subanalyis to assess the component of R.E.N.A.L nephrometry score, L component (location relative to the polar lines, HR 0.63; 95% CI (0.38-1.03); P = 0.064) was relatively important component for pentafecta achievement.
Conclusions: RAPN may be considered a safe and feasible surgical approach ensuring good functional outcome, even in our initial experience.

キーワード

臓器別:腎・尿路・膀胱

手法別:手術療法

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