Oncological and functional outcomes of open versus laparoscopic partial nephrectomy in T1b tumors: A single-center analysis

ABSTRACT Purpose: This study aims to evaluate the oncological and functional results of open partial nephrectomy (OPN) and laparoscopic partial nephrectomy (LPN) at the T1b clinical stage, which constitutes 25% of renal cell carcinomas (RCC) at diagnosis. Materials and Methods: The characteristics of 63 patients with stage T1b solitary tumor who underwent OPN (41) or LPN (22) were compared. The survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the factors affecting disease-free survival. Potential predictive factors, which might affect the postoperative glomerular filtration rate (GFR), were evaluated using multivariate linear regression analysis. Results: No differences were observed between OPN and LPN groups regarding patient and tumor characteristics. Although the warm ischemia time, intraoperative estimated blood loss, and operation duration were higher in the LPN group, no differences were noted between the two techniques regarding complication rates (p<0.001, p=0.023, p≤0.001, and p=0.190, respectively). The median hospitalization time was shorter in the LPN group than that in the OPN group (4 and 5 days, respectively), with less severe complications. No intergroup differences were observed regarding cancer-specific survival (CSS), disease-free survival (DFS), and overall survival (OS). The evaluation of the factors affecting DFS showed that age was an effective parameter (RR = 1.112, 95% CI: 1.010–8.254), but the surgical technique was not. Conclusion: No differences were observed between OPN and LPN techniques between oncological and functional outcomes in patients with clinical stage T1b RCC.

摘要
目的：本研究旨在评估临床T1b期开放性部分肾切除术（open partial nephrectomy, OPN）与腹腔镜下部分肾切除术（laparoscopic partial nephrectomy, LPN）的肿瘤学与功能结局；该分期肿瘤在确诊的肾细胞癌（renal cell carcinoma, RCC）中占比达25%。
材料与方法：本研究纳入63例单发T1b期肾肿瘤患者，分别接受开放性部分肾切除术（41例）与腹腔镜下部分肾切除术（22例），对比两组的临床特征。采用卡普兰-迈耶（Kaplan-Meier）法进行生存分析，通过单因素及多因素Cox回归分析明确影响无病生存期的相关因素。采用多因素线性回归分析评估可能影响术后肾小球滤过率（glomerular filtration rate, GFR）的潜在预测因素。
结果：两组患者的基线特征与肿瘤特征均无显著差异。尽管腹腔镜下部分肾切除术组的热缺血时间更长、术中估计失血量更多、手术时长更久，对应P值分别为<0.001、0.023、≤0.001，但两组并发症发生率无显著差异（P=0.190）。腹腔镜下部分肾切除术组的中位住院时长较开放性部分肾切除术组更短（分别为4天与5天），且严重并发症发生率更低。两组的癌症特异性生存期（cancer-specific survival, CSS）、无病生存期（disease-free survival, DFS）及总生存期（overall survival, OS）均无组间差异。对影响无病生存期的因素分析显示，年龄为有效影响因素（风险比RR=1.112，95%置信区间CI：1.010~8.254），而手术方式并非影响因素。
结论：针对临床T1b期肾细胞癌患者，开放性部分肾切除术与腹腔镜下部分肾切除术的肿瘤学结局与功能结局均无显著差异。