Trifecta Outcomes in Multifocal Tumors: A Comparison Between Robotic and Open Partial Nephrectomy

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Surgical resection is the primary treatment for unilateral, synchronous, multifocal renal tumors.
• Comparing open and robotic partial nephrectomy outcomes is crucial for complex cases.

Purpose of the Study:

• To compare outcomes of open versus robotic partial nephrectomy for multiple renal tumors in a single kidney.
• To evaluate the "trifecta" outcome, defined by negative margins, no complications, and preserved kidney function.

Main Methods:

• Retrospective review of 110 patients undergoing open or robotic partial nephrectomy for multifocal renal tumors.
• Application of Inverse Probability of Treatment Weighting (IPTW) to balance patient characteristics.
• Analysis of trifecta rates, margin status, complications, and glomerular filtration rate (GFR) preservation.

Main Results:

• After IPTW, no significant differences in baseline characteristics were observed between groups.
• Robotic and open partial nephrectomy demonstrated equivalent trifecta rates (16.3% vs 16.5%, p=0.99).
• The robotic cohort experienced a shorter mean length of stay (3.4 vs 4.9 days, p<0.001).

Conclusions:

• Both open and robotic partial nephrectomy are equally effective in achieving trifecta outcomes for multifocal renal tumors.
• Robotic partial nephrectomy is a safe and feasible option for carefully selected patients with complex renal tumors.
• The choice of approach should consider patient selection and surgical expertise.