机器人和腹腔镜肾上腺切除术治疗嗜铬细胞瘤：一项国际多中心研究。
Robotic and Laparoscopic Adrenalectomy for Pheochromocytoma: An International Multicenter Study.
发表日期：2024 Sep 14
作者：
Alessandro Parente, Kevin Verhoeff, Yanbo Wang, Nanya Wang, Zhicheng Wang, Maciej Śledziński, Andrzej Hellmann, Marco Raffaelli, Francesco Pennestrì, Mark Sywak, Alexander J Papachristos, Fausto F Palazzo, Tae-Yon Sung, Byung-Chang Kim, Yu-Mi Lee, Fiona Eatock, Hannah Anderson, Maurizio Iacobone, Albertas Daukša, Ozer Makay, Yigit Turk, Hafize Basut Atalay, Els J M Nieveen van Dijkum, Anton F Engelsman, Isabelle Holscher, Gabriele Materazzi, Leonardo Rossi, Chiara Becucci, Susannah L Shore, Clare Fung, Alison Waghorn, Radu Mihai, Sabapathy P Balasubramanian, Arslan Pannu, Shuichi Tatarano, David Velázquez-Fernández, Julie A Miller, Hazel Serrao-Brown, Yufei Chen, Marco Stefano Demarchi, Reza Djafarrian, Helen Doran, Kelvin Wang, Michael J Stechman, Helen Perry, Johnathan Hubbard, Cristina Lamas, Philippa Mercer, Janet MacPherson, Supanut Lumbiganon, María Calatayud, Felicia Alexandra Hanzu, Oscar Vidal, Marta Araujo-Castro, Cesar Minguez Ojeda, Theodosios Papavramidis, Pablo Rodríguez de Vera Gómez, Abdulaziz Aldrees, Tariq Altwjry, Nuria Valdés, Cristina Álvarez-Escola, Iñigo García Sanz, Concepción Blanco Carrera, Laura Manjón-Miguélez, Paz De Miguel Novoa, Mónica Recasens, Rogelio García Centeno, Cristina Robles Lázaro, Klaas Van Den Heede, Sam Van Slycke, Theodora Michalopoulou, Sebastian Aspinall, Ross Melvin, Joel Wen Liang Lau, Wei Keat Cheah, Man Hon Tang, Han Boon Oh, John Ayuk, Robert P Sutcliffe,
来源：
European Urology Focus
摘要：
机器人肾上腺切除术（RA）作为嗜铬细胞瘤患者腹腔镜肾上腺切除术（LA）的替代方案引起了人们的兴趣，尽管其有益效果尚不确定。我们的目的是比较这些患者的 RA 和 LA 结果。我们回顾了 2012 年至 2022 年间在 46 个国际中心因嗜铬细胞瘤接受 RA 或 LA 的患者的数据。我们分析了出院时、90 天和 1 年的基线特征和术后并发症。我们进行了倾向评分匹配（PSM；1:1 比例）和多变量分析，以评估并发症发生的结果和危险因素以及较高的综合并发症指数 (CCI)。 在 1755 名患者中，1613 名 (91.9%) 接受了 LA 治疗，142 名 (91.9%) 接受了 LA 治疗，142 名患者接受了 LA 治疗。 8.1%）接受了 RA。各组之间的估计失血量、转化率、并发症率和出院时、90 天和 1 年的 CCI 相似。然而，与 LA 相比，RA 与更长的手术时间相关（100 分钟 vs 123 分钟；p < 0.001），但 PSM 后则不然（p = 0.120）。多变量分析显示，Charlson 合并症指数（比值比 [OR] 1.17，95% 置信区间 [CI] 1.07-1.29；p = 0.001）和每 1 厘米增量的肿瘤大小（OR 1.13，95% CI 1.07-1.21；p = 0.001）。 p < 0.001）与并发症的发生率独立相关，但 LA 组和 RA 组的并发症发生率无显着差异（OR 1.09，95% CI 0.63-1.87；p = 0.767）。 PSM 后，与 LA 相比，RA 的严重（≥3a 级）并发症发生率较低 (p = 0.023)。RA 是 LA 的安全替代方案，对嗜铬细胞瘤患者产生相似的结果。 RA 可能与严重并发症的可能性较低有关。需要进一步的研究来确定机器人手术在嗜铬细胞瘤中的作用。嗜铬细胞瘤是肾上腺中的一种罕见肿瘤，金标准治疗是手术切除。我们评估了机器人辅助手术与腹腔镜手术后的患者结果，发现结果相似，但如果使用手术机器人，严重并发症的发生率可能会更低。版权所有 © 2024 欧洲泌尿外科协会。由 Elsevier B.V. 出版。保留所有权利。
Robotic adrenalectomy (RA) has attracted interest as an alternative to laparoscopic adrenalectomy (LA) for patients with pheochromocytoma, although its beneficial effects are uncertain. Our aim was to compare RA and LA outcomes for these patients.Data for patients who underwent RA or LA for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed. We analyzed baseline characteristics and postoperative complications at discharge, 90 d, and 1 yr. We conducted propensity score matching (PSM; 1:1 ratio) and multivariable analyses to evaluate outcomes and risk factors for the occurrence of complications and higher Comprehensive Complication Index (CCI).Of 1755 patients, 1613 (91.9%) underwent LA and 142 (8.1%) underwent RA. Estimated blood loss, conversion rate, complication rate, and CCI at discharge, 90 d, and 1 yr were similar between the groups. However, RA was associated with a longer operative time in comparison to LA (100 vs 123 min; p < 0.001), but not after PSM (p = 0.120). Multivariable analysis revealed that Charlson comorbidity index (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.07-1.29; p = 0.001), and tumor size per 1-cm increment (OR 1.13, 95% CI 1.07-1.21; p < 0.001) were independently associated with the incidence of complications, but there was no significant difference in complication rates between the LA and RA groups (OR 1.09, 95% CI 0.63-1.87; p = 0.767). After PSM, RA was associated with a lower rate of severe (grade ≥3a) complications in comparison to LA (p = 0.023).RA is a safe alternative to LA and yields similar outcomes for patients with pheochromocytoma. RA may be associated with a lower likelihood of severe complications. Further studies are warranted to determine the role of robotic surgery in pheochromocytoma.Pheochromocytoma is a rare tumor in the adrenal gland and the gold-standard treatment is surgical removal. We assessed patient outcomes after robot-assisted surgery compared with laparoscopic surgery and found that outcomes are similar, but the rate of severe complications may be lower if a surgical robot is used.Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.