Trifecta Outcomes in Open, Laparoscopy or Robotic Partial Nephrectomy: Does the Surgical Approach Matter?

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Partial nephrectomy (PN) is a standard treatment for renal tumors.
• Evaluating perioperative outcomes and success rates of different PN approaches is crucial.
• Trifecta achievement (no complications, negative margins, ischemia <30 min) is a key metric for successful PN.

Purpose of the Study:

• To compare perioperative outcomes of open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robot-assisted partial nephrectomy (RAPN).
• To identify predictive factors for achieving Trifecta outcomes in patients undergoing PN.
• To assess the efficacy and cost-effectiveness of different PN techniques.

Main Methods:

• Retrospective review of 55 patients who underwent PN between January 2011 and July 2018.
• Data collected included tumor characteristics, operative details, and perioperative outcomes.
• Trifecta achievement was defined as absence of perioperative complications, no positive surgical margins, and ischemia time <30 minutes.

Main Results:

• Blood loss was significantly higher in OPN compared to LPN and RAPN (P=0.042).
• Drain removal time was longer for OPN than for LPN and RAPN (P=0.008).
• Trifecta outcomes were similar across OPN (73.1%), LPN (64.3%), and RAPN (61.53%) (P=0.730).

Conclusions:

• No significant difference in Trifecta outcomes was observed among OPN, LPN, and RAPN.
• Laparoscopic partial nephrectomy demonstrates comparable results to robot-assisted partial nephrectomy.
• LPN is a viable and cost-effective option for PN, particularly in resource-limited settings.