Safety and early effectiveness of robot-assisted partial nephrectomy for large angiomyolipomas.

Autor: Golan S; Section of Urology, University of Chicago, Chicago, IL, USA., Johnson SC; Section of Urology, University of Chicago, Chicago, IL, USA., Maurice MJ; The Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Kaouk JH; The Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA., Lai WR; Department of Urology, Tulane University, New Orleans, LA, USA., Lee BR; Department of Urology, Tulane University, New Orleans, LA, USA., Kheyfets SV; Department of Urology, Indiana University, Indianapolis, IN, USA., Sundaram CP; Department of Urology, Indiana University, Indianapolis, IN, USA., Cahn DB; Division of Urologic Oncology and Urology, Fox Chase Cancer Center, Philadelphia, PA, USA., Uzzo RG; Division of Urologic Oncology and Urology, Fox Chase Cancer Center, Philadelphia, PA, USA., Shalhav AL; Section of Urology, University of Chicago, Chicago, IL, USA.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2017 May; Vol. 119 (5), pp. 755-760. Date of Electronic Publication: 2017 Jan 12.
DOI: 10.1111/bju.13747
Abstrakt: Objective: To evaluate a multicentre series of robot-assisted partial nephrectomy (RAPN) performed for the treatment of large angiomyolipomas (AMLs).
Patients and Methods: Between 2005 and 2016, 40 patients with large or symptomatic AMLs underwent RAPN at five academic centres in the USA. Patient demographics, AML characteristics, operative and postoperative clinical outcomes were recorded and analysed. Surgical outcomes were compared between patients who underwent selective arterial embolisation (SAE) before RAPN and patients who did not undergo pre-RAPN SAE.
Results: The median (interquartile range [IQR]) tumour diameter was 7.2 (5-8.5) cm, and the median (IQR) nephrometry score was 9 (7-10). Six patients (15%) had a history of tuberous sclerosis and 11 (28%) had previously undergone SAE. The median (IQR) operative time and warm ischaemia time was 207 (180-231) and 22.5 (16-28) min, respectively. A non-clamping technique was used in eight (20%) patients. The median (IQR) estimated blood loss was 200 (100-245) mL, and four patients (10%) received blood transfusion postoperatively. One intraoperative complication occurred (2.5%), and seven postoperative complications occurred in six patients (15%). During a median (IQR) follow-up of 8 (1-15) months, none of the patients developed AML-related symptoms. The median estimated glomerular filtration rate preservation rate was 95%. There were no differences in operative or perioperative outcomes between patients who underwent SAE before RAPN and those who did not.
Conclusions: Robot-assisted partial nephrectomy appears to be a safe primary or secondary (post-SAE) treatment for large AMLs, with a favourable perioperative morbidity profile and excellent functional preservation. Longer follow-up is required to fully evaluate therapeutic efficacy.
(© 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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