| المؤلفون: |
Okhawere KE; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Rich JM; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Beksac AT; Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA., Zuluaga L; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Saini I; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Ucpinar B; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Levieddin J; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Joel IT; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.; Department of Radiology, University College Hospital, Ibadan, Nigeria., Deluxe A; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Stifelman MD; Department of Urology, Hackensack University Medical Center, Hackensack, New Jersey, USA., Crivellaro S; Department of Urology, University of Illinois, Chicago, Illinois, USA., Abaza R; Central Ohio Urology Group, Columbus, Ohio, USA., Eun DD; Department of Urology, Lewis Katz School of Medicine Temple University, Philadelphia, Pennsylvania, USA., Bhandari A; Division of Urology, Mount Sinai Medical Center, Miami Beach, Florida, USA., Hemal AK; Department of Urology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA., Porter J; Department of Urology, Swedish Medical Center, Seattle, Washington, USA., Mansour A; Department of Urology, University of Texas Health Science Center, San Antonio, Texas, USA., Pierorazio PM; Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Zaytoun O; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Badani KK; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. |
| مستخلص: |
Introduction: We aim to compare transperitoneal (TP) and retroperitoneal (RP) robotic partial nephrectomy (RPN) in obese patients. Obesity and RP fat can complicate RPN, especially in the RP approach where working space is limited. Materials and Methods: Using a multi-institutional database, we analyzed 468 obese patients undergoing RPN for a renal mass (86 [18.38%] RP, 382 [81.62%] TP). Obesity was defined as body mass index ≥30 kg/m 2 * . A 1:1 propensity score matching was performed adjusting for age, previous abdominal surgery, tumor size, R.E.N.A.L nephrometry score, tumor location, surgical date, and participating centers. Baseline characteristics and perioperative and postoperative data were compared. Results: In the propensity score-matched cohort, 79 (50%) TP patients were matched with 79 (50%) RP patients. The RP group had more posterior tumors (67 [84.81%], RP versus 23 [29.11%], TP; P < .001), while the other baseline characteristics were comparable. Warm ischemia time (interquartile range; 15 [10, 12], RP versus 14 [10, 17] minutes, TP; P = .216), operative time (129 [116, 165], RP versus 130 [95, 180] minutes, TP; P = .687), estimated blood loss (50 [50, 100], RP versus 75 [50, 150] mL, TP; P = .129), length of stay (1 [1, 1], RP versus 1 [1, 2] day, TP; P = .319), and major complication rate (1 [1.27%], RP versus 3 [3.80%], TP; P = .620) were similar. No significant difference was observed in positive surgical margin rate and delta estimated glomerular filtration at follow-up. Conclusion: TP and RP RPN yielded similar perioperative and postoperative outcomes in obese patients. Obesity should not be a factor in determining optimal approach for RPN. |
