Trends and outcomes in contemporary management renal cell carcinoma and vena cava thrombus.

Autor: Beksac AT; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Shah QN; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Paulucci DJ; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Lo JZ; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Okhawere KE; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Elbakry AA; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Dayal BD; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Mehrazin R; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Eun D; Department of Urology, Temple University School of Medicine, Philadelphia, PA., Hemal A; Department of Urology, Wake Forest School of Medicine, Winston-Salem, NC., Abaza R; Robotic Urologic Surgery, Ohio Health Dublin Methodist Hospital, Columbus, OH., Sfakianos JP; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY., Badani KK; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: ketan.badani@mountsinai.org.
Jazyk: angličtina
Zdroj: Urologic oncology [Urol Oncol] 2019 Sep; Vol. 37 (9), pp. 576.e17-576.e23. Date of Electronic Publication: 2019 Jun 05.
DOI: 10.1016/j.urolonc.2019.05.010
Abstrakt: Introduction: We sought to analyze the safety, efficacy, and national trends in the use of robotic radical nephrectomy (RN) and inferior vena cava thrombectomy in patients with renal cell carcinoma.
Patients and Methods: We analyzed 872 patients from the National Cancer Database dataset who underwent open (n = 838, 96.1%) or robotic (n = 34, 3.9%) radical nephrectomy with inferior vena cava thrombectomy for cT3b renal cell carcinoma between 2010 and 2014. Length of stay (LOS), 30-day readmissions and 30-day mortality were compared between the 2 groups. As internal validation, we performed a multi-institutional analysis of 20 patients (9 open [45%] vs. 11 robotic [55%]) undergoing RN with a level II thrombus. Patients were compared in terms of baseline characteristics, peri- and postoperative outcomes. Uni- and multivariable models were used adjusting for clinical and tumor characteristics.
Results: Baseline characteristics were similar between the 2 groups in both datasets. In the National Cancer Database, robotic approach was associated with 26% reduction in LOS (P < 0.001) but no difference in readmissions (odds ratio [OR] = 0.91; 95% confidence interval [CI] = 0.05, 4.50; P = 0.925) or 30-day mortality (OR = 2.72; 95% CI = 0.40, 10.86; P = 0.211). In multicenter database, open group had significantly greater blood loss (600 vs. 100.0 mL, P = 0.020). The rate of blood transfusion was higher in the open group, but was not significant (44.4% vs. 18.2%, P = 0.336). Robotic group had a shorter LOS (1 vs. 5 days; P = 0.026). No difference was seen between the open and robotic groups in terms of operative time (226 vs. 260 minutes, P = 0.922) and postoperative complications (P > 0.999).
Conclusion: In select cases and experienced hands, robotic approach offers a reasonable alternative to open surgery without an increased complication rate.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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