Pre-operative factors that predict trifecta and pentafecta in robotic assisted partial nephrectomy

Area of Science:

• Urology
• Robotic Surgery
• Nephrology

Background:

• Robotic-assisted partial nephrectomy (RAPN) is increasingly used for renal tumor ablation.
• Defining optimal outcomes, such as trifecta and pentafecta, is crucial for patient management.
• Predictive factors for achieving these outcomes require further investigation.

Purpose of the Study:

• To prospectively identify pre-operative factors predicting trifecta and pentafecta achievement post-RAPN.
• To analyze the association between clinical variables and successful RAPN outcomes.

Main Methods:

• Clinical data from 330 RAPN procedures for single renal tumors were analyzed.
• Trifecta: warm ischemia time (WIT) ≤ 25 min, negative margins, no Clavien grade ≥ 3 complications.
• Pentafecta: Trifecta criteria plus >90% estimated glomerular filtration rate (eGFR) preservation and no CKD stage upgrade at 12 months.

Main Results:

• Trifecta was achieved in 84.8% of patients (280/330).
• Pentafecta was achieved in 25.8% of patients with 12-month eGFR data (39/152).
• A lower R.E.N.A.L. score significantly predicted both trifecta (OR 3.38) and pentafecta (OR 2.83) achievement (p < 0.001).

Conclusions:

• The R.E.N.A.L. score is the sole pre-operative predictor for trifecta and pentafecta success in RAPN.
• Lower estimated blood loss (EBL) and operative time were associated with trifecta achievement.
• EBL and operative time did not significantly impact pentafecta outcomes.