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Robot Yardımlı Parsiyel Nefrektomi: İlk 56 Hastamızda Cerrahi Teknik ve Onkolojik Sonuçların Değerlendirilmesi

Year 2019, Volume: 26 Issue: 1, 72 - 79, 04.03.2019
https://doi.org/10.17343/sdutfd.441442

Abstract

Amaç: Kliniğimizde böbrek
tümörü nedeniyle robot yardımlı  parsiyel
nefrektomi (RYPN) yapılan ilk 56 hastamızda cerrahi teknik ve onkolojik
sonuçların değerlendirilmesi.

Materyal ve metod: Mart
2015 ile Şubat 2018 tarihleri arasında RYPN yapılan 56 hastanın  prospektif olarak toplanan verileri geriye
dönük olarak analiz edildi. Preoperatif kan parametrelerinde hemoglobin, serum
üre/kreatinin ve karaciğer fonksiyon testleri bakıldı. Perioperatif
parametrelerde; ameliyat ve iskemi süreleri ile kan transfüzyonları kaydedildi.
Postoperatif olarak hemoglobin değerleri ve patolojik sonuçlar incelendi.

Bulgular: Yaşları
ortalama 59 yıl (32-84) olan 44 erkek ve 12 kadın hastaya transperitoneal
yaklaşınla RYPN uygulandı. Ortalama tümör çapı 3.8 cm (1.5-8) olan 27 sağ, 29 sol
renal ünite opere edildi. Ortalama operasyon süresi 151 dk  (90-250), ortalama sıcak iskemi süresi 24.5
dk (18-35), ortalama kan kaybı 63 ml
(25-100) idi. Bir hastada (% 1.7) transfüzyon gerektiren perirenal hematom
gözlendi. Hiçbir hastada açık cerrahiye dönülme ihtiyacı olmadı ve hiçbir
hastada nefrektomi gerekmedi. Sekiz hastada pelvikaliksiyel sistem açıldığı
için onarım yapıldı ancak hiçbirisine üreteral stent yerleştirme ihtiyacı
duyulmadı. Böbrekteki kitlelerin % 78.5’i primer renal hücreli karsinom olarak
raporlandı ve 4 hastada (% 9.0) cerrahi sınır pozitif olarak belirtildi.
Hastaların ortalama takip süresi 13(4-36) aydı ve hiçbir hastada lokal
rekürrens ya da uzak metastaz görülmedi. Hiçbir hastada insizyonel herni gibi
geç dönem komplikasyon izlenmedi.







Sonuç: RYPN, iyi seçilmiş evre
1 böbrek tümörlerinde güvenle uygulanabilen bir cerrahi yöntemdir. Cerraha
sağladığı sütür atma kolaylığı ve hareket serbestliği sayesinde sıcak iskemi
süresini makul düzeylerde tutarak,  öngörülen
onkolojik ve fonksiyonel sonuçlara, düşük morbidite ile ulaşılmasını sağlar.

References

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  • 2. Chawla S.N., Crispen P.L., Hanlon A.L., Greenberg R.E., Chen D.Y., Uzzo R.G. The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. The Journal of urology, 2006; 175(2), 425-431.
  • 3. Gill I.S., Kavoussi L.R., Lane B.R., Blute M.L., Babineau D., Colombo J.R., Kattan M.W. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. The Journal of urology, 2007; 178(1), 41-46.
  • 4. Weight C.J., Lieser G., Larson B.T., Gao T., Lane B.R., Campbell S.C., Fergany A. F. Partial nephrectomy is associated with improved overall survival compared to radical nephrectomy in patients with unanticipated benign renal tumours. European urology, 2010; 58(2), 293-298.
  • 5. Mitchell R.E., Gilbert S.M., Murphy A.M., Olsson C.A., Benson M.C., McKiernan J.M. Partial nephrectomy and radical nephrectomy offer similar cancer outcomes in renal cortical tumors 4 cm or larger. Urology, 2006; 67(2), 260-264.
  • 6. Touijer K., Jacqmin D., Kavoussi L.R., Montorsi F., Patard J.J., Rogers C.G., Van Poppel H. The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications. European urology, 2010; 57(2), 214-222.
  • 7. Novick A.C., Derweesh I. Open partial nephrectomy for renal tumours: current status. BJU international, 2005; 95(s2), 35-40.
  • 8. Ljungberg B., Cowan N.C., Hanbury D.C., Hora M., Kuczyk M.A., Merseburger A.S., Sinescu I.C. EAU guidelines on renal cell carcinoma: the 2010 update. European urology, 2010; 58(3), 398-406.
  • 9. Marszalek M., Meixl H., Polajnar M., Rauchenwald M., Jeschke, K., Madersbacher S. Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. European urology, 2009; 55(5), 1171-1178.
  • 10. Benway B.M., Bhayani S.B., Rogers C.G., Dulabon L.M., Patel M.N., Lipkin M., Stifelman M.D. Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. The Journal of urology, 2009; 182(3), 866-873.
  • 11. Link R.E., Bhayani S.B., Allaf M.E., Varkarakis I., Inagaki T., Rogers C., Kavoussi L.R. Exploring the learning curve, pathological outcomes and perioperative morbidity of laparoscopic partial nephrectomy performed for renal mass. The Journal of urology, 2005; 173(5), 1690-1694.
  • 12. Kural A.R., Atug F. The applications of robotic surgery in urology. Turkish Journal of Urology, 2010; 36(3), 248-258.
  • 13. Ljungberg B., Albiges L., Bensalah K., Bex A., Giles R.H., Hora M., Powles T. EAU Guidelines on renal cell carcinoma. European Association of Urology 2017. Update March.
  • 14. Simmons M.N., Weight C.J., Gill I.S. Laparoscopic radical versus partial nephrectomy for tumors> 4 cm: intermediate-term oncologic and functional outcomes. Urology, 2009; 73(5), 1077-1082.
  • 15. Van Poppel H., Da Pozzo L., Albrecht W., Matveev V., Bono A., Borkowski A., Marreaud S. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. European urology, 2011; 59(4), 543-552.
  • 16. Thompson R.H., Frank I., Lohse C.M., Saad I.R., Fergany A., Zincke H., Novick A.C. The impact of ischemia time during open nephron sparing surgery on solitary kidneys: a multi-institutional study. The Journal of urology, 2007; 177(2), 471-476.
  • 17. Muramaki M., Miyake H., Sakai I., Fujisawa M. Prognostic factors influencing postoperative development of chronic kidney disease in patients with small renal tumors who underwent partial nephrectomy. Current urology, 2012; 6(3), 129-135.
  • 18. Benway B.M., Bhayani S.B. Surgical outcomes of robot‐assisted partial nephrectomy. BJU international, 2011; 108(6b), 955-961.
  • 19. Cho C.L., Ho K.L., Chu S.S., Tam P.C. Robot-assisted versus standard laparoscopic partial nephrectomy: comparison of perioperative outcomes from a single institution. Hong Kong Medical Journal 2011; v. 17 n. 1, p. 33-38
  • 20. Deane L.A., Lee H.J., Box G.N., Melamud O., Yee D.S., Abraham J.B.A., Ornstein D.K. Robotic versus standard laparoscopic partial/wedge nephrectomy: a comparison of intraoperative and perioperative results from a single institution. Journal of endourology, 2008; 22(5), 947-952.
  • 21. DeLong J.M., Shapiro O., Moinzadeh A. Comparison of laparoscopic versus robotic assisted partial nephrectomy: one surgeon's initial experience. The Canadian journal of urology, 2010; 17(3), 5207-5212.
  • 22. Yossepowitch O., Thompson R.H., Leibovich B.C., Eggener S.E., Pettus J.A., Kwon E.D., Russo P. Positive surgical margins at partial nephrectomy: predictors and oncological outcomes. The Journal of urology, 2008; 179(6), 2158-2163.
  • 23. Scoll B.J., Uzzo R.G., Chen D.Y., Boorjian S.A., Kutikov A., Manley B.J., Viterbo R. Robot-assisted partial nephrectomy: a large single-institutional experience. Urology, 2010; 75(6), 1328-1334.
  • 24. Mottrie A., De Naeyer G., Schatteman P., Carpentier P., Sangalli M., Ficarra V. Impact of the learning curve on perioperative outcomes in patients who underwent robotic partial nephrectomy for parenchymal renal tumours. European urology, 2010; 58(1), 127-133.
  • 25. Rogers C.G., Menon M., Weise E.S., Gettman M.T., Frank I., Shephard D.L., Bhayani S.B. Robotic partial nephrectomy: a multi-institutional analysis. Journal of robotic surgery, 2008; 2(3), 141-143.
  • 26. Benway B.M., Bhayani S.B., Rogers C.G., Dulabon L.M., Patel M.N., Lipkin M., Stifelman M.D. Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. The Journal of urology, 2009; 182(3), 866-873.
  • 27. Kim S.P., Abouassaly R. Treatment of Patients with Positive Margins after Partial Nephrectomy. The Journal of urology, 2016; 196(2), 301.
  • 28. Shikanov S., Wille M., Large M., Lifshitz D.A., Zorn K.C., Shalhav A.L., Eggener S.E. Knotless closure of the collecting system and renal parenchyma with a novel barbed suture during laparoscopic porcine partial nephrectomy. Journal of endourology, 2009; 23(7), 1157-1160.
  • 29. Zondervan P.J., Gozen A.S., Opondo D., Rassweiler J.J., Jean J., Laguna M.P. Partial nephrectomy: Is there an advantage of the self-retaining barbed suture in the perioperative period? A matched case–control comparison. World journal of urology, 2012; 30(5), 659-664.
  • 30. Benway B.M., Wang A.J., Cabello J.M., Bhayani S.B. Robotic partial nephrectomy with sliding-clip renorrhaphy: technique and outcomes. European Urology, 2009; 55(3), 592-599.
  • 31. Ho H., Schwentner C., Neururer R., Steiner H., Bartsch G., Peschel R. Robotic‐assisted laparoscopic partial nephrectomy: surgical technique and clinical outcomes at 1 year. BJU international, 2009; 103(5), 663-668.
Year 2019, Volume: 26 Issue: 1, 72 - 79, 04.03.2019
https://doi.org/10.17343/sdutfd.441442

Abstract

References

  • 1. Gültekin M, Boztaş G. Türkiye kanser istatistikleri. Sağlık Bakanlığı, Türkiye Halk Sağlığı Kurumu, 2014; 43.
  • 2. Chawla S.N., Crispen P.L., Hanlon A.L., Greenberg R.E., Chen D.Y., Uzzo R.G. The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. The Journal of urology, 2006; 175(2), 425-431.
  • 3. Gill I.S., Kavoussi L.R., Lane B.R., Blute M.L., Babineau D., Colombo J.R., Kattan M.W. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. The Journal of urology, 2007; 178(1), 41-46.
  • 4. Weight C.J., Lieser G., Larson B.T., Gao T., Lane B.R., Campbell S.C., Fergany A. F. Partial nephrectomy is associated with improved overall survival compared to radical nephrectomy in patients with unanticipated benign renal tumours. European urology, 2010; 58(2), 293-298.
  • 5. Mitchell R.E., Gilbert S.M., Murphy A.M., Olsson C.A., Benson M.C., McKiernan J.M. Partial nephrectomy and radical nephrectomy offer similar cancer outcomes in renal cortical tumors 4 cm or larger. Urology, 2006; 67(2), 260-264.
  • 6. Touijer K., Jacqmin D., Kavoussi L.R., Montorsi F., Patard J.J., Rogers C.G., Van Poppel H. The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications. European urology, 2010; 57(2), 214-222.
  • 7. Novick A.C., Derweesh I. Open partial nephrectomy for renal tumours: current status. BJU international, 2005; 95(s2), 35-40.
  • 8. Ljungberg B., Cowan N.C., Hanbury D.C., Hora M., Kuczyk M.A., Merseburger A.S., Sinescu I.C. EAU guidelines on renal cell carcinoma: the 2010 update. European urology, 2010; 58(3), 398-406.
  • 9. Marszalek M., Meixl H., Polajnar M., Rauchenwald M., Jeschke, K., Madersbacher S. Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. European urology, 2009; 55(5), 1171-1178.
  • 10. Benway B.M., Bhayani S.B., Rogers C.G., Dulabon L.M., Patel M.N., Lipkin M., Stifelman M.D. Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. The Journal of urology, 2009; 182(3), 866-873.
  • 11. Link R.E., Bhayani S.B., Allaf M.E., Varkarakis I., Inagaki T., Rogers C., Kavoussi L.R. Exploring the learning curve, pathological outcomes and perioperative morbidity of laparoscopic partial nephrectomy performed for renal mass. The Journal of urology, 2005; 173(5), 1690-1694.
  • 12. Kural A.R., Atug F. The applications of robotic surgery in urology. Turkish Journal of Urology, 2010; 36(3), 248-258.
  • 13. Ljungberg B., Albiges L., Bensalah K., Bex A., Giles R.H., Hora M., Powles T. EAU Guidelines on renal cell carcinoma. European Association of Urology 2017. Update March.
  • 14. Simmons M.N., Weight C.J., Gill I.S. Laparoscopic radical versus partial nephrectomy for tumors> 4 cm: intermediate-term oncologic and functional outcomes. Urology, 2009; 73(5), 1077-1082.
  • 15. Van Poppel H., Da Pozzo L., Albrecht W., Matveev V., Bono A., Borkowski A., Marreaud S. A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. European urology, 2011; 59(4), 543-552.
  • 16. Thompson R.H., Frank I., Lohse C.M., Saad I.R., Fergany A., Zincke H., Novick A.C. The impact of ischemia time during open nephron sparing surgery on solitary kidneys: a multi-institutional study. The Journal of urology, 2007; 177(2), 471-476.
  • 17. Muramaki M., Miyake H., Sakai I., Fujisawa M. Prognostic factors influencing postoperative development of chronic kidney disease in patients with small renal tumors who underwent partial nephrectomy. Current urology, 2012; 6(3), 129-135.
  • 18. Benway B.M., Bhayani S.B. Surgical outcomes of robot‐assisted partial nephrectomy. BJU international, 2011; 108(6b), 955-961.
  • 19. Cho C.L., Ho K.L., Chu S.S., Tam P.C. Robot-assisted versus standard laparoscopic partial nephrectomy: comparison of perioperative outcomes from a single institution. Hong Kong Medical Journal 2011; v. 17 n. 1, p. 33-38
  • 20. Deane L.A., Lee H.J., Box G.N., Melamud O., Yee D.S., Abraham J.B.A., Ornstein D.K. Robotic versus standard laparoscopic partial/wedge nephrectomy: a comparison of intraoperative and perioperative results from a single institution. Journal of endourology, 2008; 22(5), 947-952.
  • 21. DeLong J.M., Shapiro O., Moinzadeh A. Comparison of laparoscopic versus robotic assisted partial nephrectomy: one surgeon's initial experience. The Canadian journal of urology, 2010; 17(3), 5207-5212.
  • 22. Yossepowitch O., Thompson R.H., Leibovich B.C., Eggener S.E., Pettus J.A., Kwon E.D., Russo P. Positive surgical margins at partial nephrectomy: predictors and oncological outcomes. The Journal of urology, 2008; 179(6), 2158-2163.
  • 23. Scoll B.J., Uzzo R.G., Chen D.Y., Boorjian S.A., Kutikov A., Manley B.J., Viterbo R. Robot-assisted partial nephrectomy: a large single-institutional experience. Urology, 2010; 75(6), 1328-1334.
  • 24. Mottrie A., De Naeyer G., Schatteman P., Carpentier P., Sangalli M., Ficarra V. Impact of the learning curve on perioperative outcomes in patients who underwent robotic partial nephrectomy for parenchymal renal tumours. European urology, 2010; 58(1), 127-133.
  • 25. Rogers C.G., Menon M., Weise E.S., Gettman M.T., Frank I., Shephard D.L., Bhayani S.B. Robotic partial nephrectomy: a multi-institutional analysis. Journal of robotic surgery, 2008; 2(3), 141-143.
  • 26. Benway B.M., Bhayani S.B., Rogers C.G., Dulabon L.M., Patel M.N., Lipkin M., Stifelman M.D. Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. The Journal of urology, 2009; 182(3), 866-873.
  • 27. Kim S.P., Abouassaly R. Treatment of Patients with Positive Margins after Partial Nephrectomy. The Journal of urology, 2016; 196(2), 301.
  • 28. Shikanov S., Wille M., Large M., Lifshitz D.A., Zorn K.C., Shalhav A.L., Eggener S.E. Knotless closure of the collecting system and renal parenchyma with a novel barbed suture during laparoscopic porcine partial nephrectomy. Journal of endourology, 2009; 23(7), 1157-1160.
  • 29. Zondervan P.J., Gozen A.S., Opondo D., Rassweiler J.J., Jean J., Laguna M.P. Partial nephrectomy: Is there an advantage of the self-retaining barbed suture in the perioperative period? A matched case–control comparison. World journal of urology, 2012; 30(5), 659-664.
  • 30. Benway B.M., Wang A.J., Cabello J.M., Bhayani S.B. Robotic partial nephrectomy with sliding-clip renorrhaphy: technique and outcomes. European Urology, 2009; 55(3), 592-599.
  • 31. Ho H., Schwentner C., Neururer R., Steiner H., Bartsch G., Peschel R. Robotic‐assisted laparoscopic partial nephrectomy: surgical technique and clinical outcomes at 1 year. BJU international, 2009; 103(5), 663-668.
There are 31 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research Articles
Authors

Ekrem İslamoğlu 0000-0003-0693-0666

Çağatay Özsoy

Kaan Karamık This is me

İbrahim Erol

Mutlu Ateş

Murat Savaş This is me

Publication Date March 4, 2019
Submission Date July 6, 2018
Acceptance Date August 7, 2018
Published in Issue Year 2019 Volume: 26 Issue: 1

Cite

Vancouver İslamoğlu E, Özsoy Ç, Karamık K, Erol İ, Ateş M, Savaş M. Robot Yardımlı Parsiyel Nefrektomi: İlk 56 Hastamızda Cerrahi Teknik ve Onkolojik Sonuçların Değerlendirilmesi. Med J SDU. 2019;26(1):72-9.

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