Objective To compare the efficacy of robot assisted laparoscopic partial nephrectomy(RAPN)and laparoscopic partial nephrectomy(LPN)in the treatment of pediatric renal tumors.Methods A retrospective analysis was conducted on the clinical data of 29 children with renal tumors admitted to Xinhua Hospital from March 2019 to March 2024.Among them,there were 10 cases in the RAPN group,including 6 males and 4 females;The median age is 7.5(4,12)years old,with a tumor diameter of(4.3±1.6)cm,a median R.E.N.A.L.score of 9(8,11),and relative tumor size(tumor volume/contralateral kidney volume)of(34.0％±19.3％).There were 19 cases in the LPN group,8 males and 11 females;the median age is 5.0(4,11)years old,with a tumor diameter of(4.4±1.6)cm,a median R.E.N.A.L.score of 9(8,11),and relative tumor size(37.7％±18.1％).There was no statistically significant difference in preoperative characteristics between the two groups(P＞0.05).Both groups underwent partial nephrectomy,with renal artery occlusion and then warm ischemia.Clinical data from both groups during and postoperatively were compared,and a simple linear regression analysis was utilized to assess the correlation between the relative size of the tumor and the duration of intraoperative warm ischemia.Results All 29 cases underwent a successful surgery.Compared with the LPN group,the total surgery time in the RAPN group was(115.0±28.4)minutes versus(127.9±28.2)min(P=0.25);the warm ischemia time was(20.9±3.0)min versus(27.0±4.5)min,respectively(P＜0.01);the intraoperative bleeding was(50.0±24.5)ml and(80.0±21.2)ml(P＜0.01);the difference in hemoglobin level before and after surgery was(10.3±3.5)g/L versus(12.9±2.7)g/L(P＜0.05),respectively;the median postoperative drainage time was 3.5(3,4)days versus 4.0(3,6)days(P=0.17);the median postoperative hospital stay was 4.5(4,8)days versus 6.0(5,10)days(P＜0.05).There were 3 cases of renal cell carcinoma associated with the MiT family translocation,2 cases of mixed epithelial and stromal tumors,and 2 cases of cystic nephroma by postoperative pathological examination in the RAPN group.There were 10 cases of nephroblastoma,3 cases of teratoma,2 cases of renal cell carcinoma associated with the MiT family translocation,2 cases of metanephric adenoma,1 case of unclassified renal cell carcinoma,and 1 case of cystic nephroma in the LPN group.Apart from one child in the LPN group who developed a postoperative fever over 39℃,no other severe complications occurred during or after the surgery in the remaining patients.Compared with preoperative parameters,eGFR decreased(8.9±18.9)ml/(min·1.73m2)and(21.4±34.8)ml/(min·1.73m2)in the RAPN group and LPN group,respectively,1 month postoperatively(P=0.36);three months after surgery,eGFR was followed up,and the RAPN group and LPN group showed a decrease of(5.9±23.4)ml/(min·1.73m2)and(13.9±20.1)ml/(min·1.73m2)compared with preoperative levels,respectively(P=0.42).Linear regression analysis indicated that in the LPN group,intraoperative warm ischemia time exhibited a progressively increasing trend with the augmentation of the tumor's relative size,and warm ischemia time=0.1688 x tumor relative size+20.64,(R2=0.46,P＜0.01).Based on this,it is estimated that when the tumor's relative size exceeds 55.5％,the intraoperative warm ischemia time often surpassed 30 minutes.However,in the RAPN group,this trend is not statistically significant(P＞0.05).Conclusions Both LPN and RAPN are safe and feasible for the treatment of pediatric renal tumors.Compared with LPN,RAPN surgery has advantages of shortening warm ischemia time and reducing intraoperative bleeding,which helps patients recover early.RAPN is a better choice for children with a relative renal tumors size over 55.5％.
维普
万方数据
