Comparisons of the safety and effectiveness of robot-assisted versus laparoscopic partial nephrectomy for large angiomyo
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UROLOGY - ORIGINAL PAPER
Comparisons of the safety and effectiveness of robot‑assisted versus laparoscopic partial nephrectomy for large angiomyolipomas: a propensity score‑matched analysis Shengjie Zhang1 · Tingsheng Lin1 · Guangxiang Liu1 · Shiwei Zhang1 · Hongqian Guo1 Received: 30 December 2019 / Accepted: 6 March 2020 © Springer Nature B.V. 2020
Abstract Objective To compare the safety and effectiveness of robot-assisted partial nephrectomy (RAPN) versus laparoscopic partial nephrectomy (LPN) for large angiomyolipomas (AMLs). Materials and methods We retrospectively evaluated 150 patients who were treated with either RAPN or LPN for large angiomyolipomas from 2014 to 2018. Propensity score matching was performed on age, gender, BMI, Charlson Comorbidity Index, tumour side and size, preoperative eGFR and RENAL score. Results In total, 63 and 87 patients underwent RAPNs and LPNs, respectively. There were more large and complex AMLs in the RAPN cohort, with the median tumour maximal diameters and RENAL scores differing between the two groups (8 versus 7 cm and 9 versus 8, P = 0.01). After matching, the median warm ischemic time was significantly shorter in the RAPNs versus the LPNs (17 versus 22 min, P = 0.001). The rate of intraoperative complications in the RAPNs appeared lower than the LPNs (3.2% versus 8.1%). The median postoperative length of stay was significantly shorter in the RAPN cohort than the LPNs (P = 0.001). Twelve months after surgery, RAPNs received a 94.6% renal function prevention; while this was 90.8% in LPNs (P = 0.001). Subgroup analysis indicated that prior selective arterial embolization (SAE) was related to better renal function preservation in the RAPN cohort (P = 0.01). No recurrence occurred in either of the two cohorts. Conclusions RAPN is a safe and effective alternative to LPNs for large AMLs with a shorter warm ischemic time and higher renal preservation rate. Recurrence was equivalent in both RAPNs and LPNs. Keywords Renal · Angiomyolipomas · Partial nephrectomy · Robot-assisted · Propensity score Abbreviations RAPN Robot-assisted partial nephrectomy LPN Laparoscopic particularly nephrectomy SAE Selective arterial embolization AML Angiomyolipoma NSS Nephron-sparing surgery Shengjie Zhang, Tingsheng Lin and Guangxiang Liu equal study contribution. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11255-020-02441-x) contains supplementary material, which is available to authorized users. * Hongqian Guo [email protected] 1
Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing 210008, Jiangsu, People’s Republic of China
EBL Estimated blood loss WIT Warm ischemic time
Introduction Angiomyolipoma (AML) is a benign mesenchymal tumour composed of fat, smooth muscle and blood vessels that are prone to rupture and hemorrhage [1]. Most renal AMLs are sporadic, while some are associated with tuberous sclerosis complex (TSC) [2].
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