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Achieving the "trifecta" with open versus minimally invasive partial nephrectomy.

Samrad Ghavimi1, Olli Saarela2, Frederic Pouliot3

  • 1University of British Columbia, Level 6, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.

World Journal of Urology
|July 14, 2020
PubMed
Summary

Open, laparoscopic, and robotic partial nephrectomy (PN) for T1 renal masses were compared. Open and laparoscopic PN were more likely to achieve the trifecta outcome compared to robotic PN, primarily due to better preservation of kidney function.

Keywords:
Minimally invasive versus openPartial nephrectomyTrifecta

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Area of Science:

  • Urology
  • Surgical Oncology
  • Nephrology

Background:

  • The trifecta outcome measure in partial nephrectomy (PN) includes negative surgical margins, minimal post-operative estimated glomerular filtration rate (eGFR) decline (≤10%), and no urological complications.
  • This study evaluated trifecta achievement rates across open (OPN), laparoscopic (LPN), and robotic PN (RPN) for clinical T1 renal masses (≤7 cm).

Purpose of the Study:

  • To compare the trifecta outcome rates among patients undergoing OPN, LPN, and RPN for clinical T1 renal masses.
  • To identify predictors of trifecta achievement and its individual components across different surgical approaches.

Main Methods:

  • Data from 1708 patients treated between January 2011 and October 2018 were extracted from the Canadian Kidney Cancer Information System.
  • Statistical comparisons included Kruskal-Wallis and Chi-squared tests.
  • Multivariable analysis was employed to determine predictors of trifecta components and overall trifecta success.

Main Results:

  • Trifecta rates were 53% for OPN, 52% for LPN, and 47% for RPN (p=0.194).
  • Multivariable analysis indicated OPN and LPN were associated with less eGFR decline and higher trifecta rates compared to RPN.
  • No significant difference in trifecta rates was found between OPN and LPN. OPN showed higher negative margin rates than RPN.

Conclusions:

  • After adjusting for confounding factors, OPN and LPN demonstrated higher likelihoods of achieving the trifecta compared to RPN, mainly due to better preservation of renal function.
  • No significant difference in trifecta achievement was observed between OPN and LPN.
  • The study's limitations include the absence of nephrometry score data.