肾部分切除术与肾根治术:术后并发症及其对死亡率影响的比较

A. Houjaij, O. Darwish, Jacob Rubin, Raymond Pominville, Pradeep Arora, Mohsin Shiekh, Csaba Gajdos, Nader D. Nader
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引用次数: 0

摘要

肾部分切除术因其保留肾小球的优点而成为某些肾肿瘤的首选治疗方法。我们旨在比较局部肾细胞癌(RCC)根治性(RN)或肾部分切除术后并发症的发生率和重要性,以及对患者死亡率的影响。 2005年至2017年期间的所有RCC病例均来自国家外科质量改进计划。全因死亡率是定义并发症发生后抢救失败(FTR)的主要终点。进行倾向评分匹配(PSM)以调整两组之间的混杂变量。排除标准包括透析患者、远处转移患者和同时进行手术的患者。当P值小于0.05时,拒绝零假设。 数据库中包括 24830 名患者,其中 RN 组 22015 人,PN 组 2815 人。在 PSM 之后,2226 名接受过 PN 的患者与同等数量的接受过 RN 的患者进行了 1:1 匹配。总体而言,RN 术后并发症发生率为 20.5%,高于 PN 术后的 15.9%(P < .001)。虽然死亡率相似,但 RN 术后患者更有可能输血和再次插管,住院时间也更长,而 PN 术后患者可能出现更多感染性并发症,包括腹腔脓肿,也更有可能返回手术室。在两组患者中,心脏和呼吸系统并发症都与 FTR 相关,并导致死亡。大出血(需要输血)也是 RN 后死亡的一个重要原因,但不是 PN 后死亡的一个重要原因。 在计划进行 PN 或 RN 时,应就选择性手术的风险以及某些并发症可能增加的死亡率风险向患者提供咨询。应将这些风险与癌症手术的益处进行权衡。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Partial Versus Radical Nephrectomy: Comparison of Postoperative Complications and Contribution to Mortality
Partial nephrectomy is the preferred treatment method for certain kidney tumors owing to its nephron-preserving benefit. We aimed to compare the occurrence and importance of complications after radical (RN) or partial (PN) nephrectomy for localized renal cell carcinoma (RCC) and contribution to patient mortality. All RCC cases were extracted from the National Surgical Quality Improvement Program between 2005 and 2017. All-cause mortality was the primary endpoint that defined a failure to rescue (FTR) after the occurrences of complications. Propensity score matching (PSM) was performed to adjust for confounding variables between the 2 groups. The exclusion criteria included patients on dialysis, those with distant metastases, and those with concurrent procedures. Null hypotheses were rejected when P-values were < .05. The database included 24,830 patients, with 22,015 in the RN group and 2815 in the PN. After PSM, 2226 patients after PN were matched 1:1 to an equal number of patients who underwent RN. Overall, postoperative complications occurred in 20.5% after RN, more frequent than 15.9% after PN (P < .001). While the mortality rates were similar, patients were more likely to experience blood transfusion and reintubation, as well as longer hospital stay after RN, while they were likely to have more infectious complications, including abdominal abscess, and more likely to return to the operating room after PN. In both groups, cardiac and respiratory complications were associated with FTR, leading to mortality. Excessive bleeding (requiring transfusion) was also a significant cause of death after RN but not after PN. When planning PN or RN, patients should be counseled on the risks of their selective procedure and the potential increased mortality risk with certain complications. These risks should be weighed against the benefit of those cancer surgeries.
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