Comparison of robot-assisted partial nephrectomy with KangDuo surgical system vs. the da Vinci Si system: Quality of life and medium-term oncological outcomes

摘要

To the Editor: Renal cell carcinoma is the most common cancer of the genitourinary tract and leads to over 170,000 deaths annually worldwide. For localized tumors, robot-assisted partial nephrectomy (RAPN) has emerged as a popular option due to its numerous benefits, including better ergonomics, better functional outcomes, similar oncological outcomes, and minimal invasiveness. The KangDuo surgical robot (KD-SR), a novel robotic surgical platform, was developed by SuZhou KangDuo Robot Co., Ltd. (Suzhou, China). Recently, we reported that the KD-SR achieved noninferior outcomes compared to the da Vinci Si Surgical System (DV-SS-Si) in terms of surgical success for T1a tumors.[1] However, the oncological outcomes of the KD-SR and the DV-SS-Si are yet to be compared. In this prospective randomized cohort trial, we aimed to compare the patient-reported health-related quality of life (HRQoL) and medium-term oncological outcomes of the KD-SR vs. the DV-SS-Si for RAPN. This study was based on a double-center randomized controlled study conducted from September 2020 to March 2021 in Peking University First Hospital and Peking Union Medical College Hospital.[1] It is registered at www.chictr.org.cn (ChiCTR2100045983). Patients aged 18–75 years with a suspicion of T1aN0M0 renal cancer (R.E.N.A.L. Nephrometry Score ≤9) were included. The exclusion criteria were pregnancy and contraindication for anesthesia. The trial group accepted RAPN with KD-SR (KD-SR group), while the control group accepted RAPN with DV-SS-Si (DV-SS-Si group). The basic surgical procedures were similar to those published previously.[1] After the preparation of the renal hilum and exposure of the tumor, bulldog clips were introduced for renal hilar clamping. The tumor was completely resected approximately 0.5 cm from the edge of the tumor and the resulting renal wound was closed with running sutures. The bulldog clamps were removed after adequate hemostasis. All surgeries were performed by expert surgeons with experience of >100 standard robotic surgical procedures. In Peking University First Hospital, 60 patients were enrolled, and we further prospectively collected their HRQoL data and oncological outcomes here. Patients who did not receive allocated intervention or those without follow-up information were excluded [Figure 1A]. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.Figure 1: The study design and the performance of HRQoL. (A) Diagram of study enrollment and final analysis cohort; (B) HRQoL data before treatment and the score changes at 3 months postoperatively in mean ± SD or median (Q1, Q3); (C) HRQoL comparison before treatment and at 3 months postoperatively in the KD-SR and DV-SS-Si groups. The global health status and functional domains comparison between KD-SR and DV-SS-Si (1) before treatment and (2) at 3 months postoperatively; the global health status and functional domains comparison for before treatment and at 3 months postoperatively in (3) KD-SR and (4) DV-SS-Si; HRQoL symptom domains comparison between KD-SR and DV-SS-Si (5) before treatment and (6) at 3 months postoperatively; Symptom domains comparison for before treatment and at 3 months postoperatively in (7) KD-SR and (8) DV-SS-Si. Significance of difference was tested using the Mann–Whitney U for (1), (2), (5), (6), and Wilcoxon-test for (3), (4), (7), (8). Only P-values <0.05 are shown. *Significance of difference was tested using the Mann–Whitney U test. †Significance of difference was tested using the independent samples t-test. DV-SS-Si: da Vinci Si surgical system; HRQoL: Health-related quality of life; KD-SR: KangDuo surgical robot; SD: Standard deviation.HRQoL was measured by the European Organization for the Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30), which was administered 1 day before surgery and 3 months after surgery. The primary endpoints were longitudinal