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Robot-Assisted Partial Nephrectomy for T1b Tumors: Strict Trifecta Outcomes.
Ilter Tufek1, Panagiotis Mourmouris1, Tunkut Doganca2
1Department of Urology, School of Medicine, Istanbul Acıbadem University, Istanbul, Turkey.
JSLS : Journal of the Society of Laparoendoscopic Surgeons
|March 30, 2017
Summary
Robot-assisted partial nephrectomy (RAPN) for T1b renal masses achieved excellent outcomes. Most patients met strict Trifecta criteria, demonstrating safety and effectiveness with no tumor recurrence.
Area of Science:
- Urology
- Surgical Oncology
- Robotic Surgery
Background:
- The
- Trifecta
- in partial nephrectomy is defined by negative surgical margins, minimal renal function decrease, and absence of complications.
- Robot-assisted partial nephrectomy (RAPN) is increasingly utilized for renal masses.
Purpose of the Study:
- To evaluate the single-center experience with RAPN for T1b renal masses (4-7 cm).
- To assess outcomes based on strict Trifecta criteria: negative margins, ≤15% eGFR decrease, ≤25 min warm ischemia time (WIT), and no Clavien-Dindo grade ≥2 complications.
Main Methods:
- Retrospective analysis of 50 patients with T1b renal masses undergoing RAPN by a single surgeon.
- Data collected included preoperative, intraoperative, and postoperative parameters.
- Statistical significance was set at P < .05.
Main Results:
- All 50 patients achieved negative surgical margins.
- Mean WIT was 20.8 ± 6.2 minutes; 18% had WIT >25 minutes.
- 58% of patients achieved strict Trifecta outcomes; 22% had >15% eGFR decrease; 8% had complications (grade ≥2).
- No tumor recurrence was observed during a mean follow-up of 44.2 months.
Conclusions:
- RAPN for T1b renal masses is safe and effective in experienced hands.
- High rates of strict Trifecta outcomes and oncologic control can be achieved.
