Comparative Analysis of Trifecta Outcomes in Robot-Assisted Partial Nephrectomy for cT1a Versus cT1b + Renal...

Robotic assistance is being increasingly utilised for nephron-sparing surgery for complex renal masses. We evaluated the outcomes of robot-assisted partial nephrectomy (RAPN) for cT1a versus cT1b + renal masses by a comparative analysis of trifecta outcomes between these two groups of patients. We utilised our prospectively maintained database to identify patients undergoing RAPN for cT1a (group 1, n = 41) and cT1b + (group 2, n = 37) renal masses from April 2016 to March 2020. The oncological and trifecta outcomes were analysed using appropriate statistical methods. Out of 78 patients, trifecta was achieved in 30 (38.4%) patients. There was no statistically significant difference in trifecta between cT1a and cT1b + tumours (p = 0.152). We found a statistically significant difference between the two groups in terms of RENAL scores (p = 0.0005), PADUA score (p = 0.0002), and robotic console time (133.8 ± 42.8 Vs 170 ± 54.8 min for cT1a versus cT1b + , respectively) (p = 0.002). On multivariate analysis, warm ischemia time (p = 0.069), blood loss (p = 0.345), UCS repair (p = 0.691) and GFR reduction (p = 0.152) were not statistically different. There was no statistically significant difference in intraoperative and post-operative complications (p = 0.9317) or length of hospital stay (p = 0.112). Although recurrences were observed in two patients (5.4%) of the cT1b group, there was no statistical difference in the recurrence-free survival at 12 and 24 months. Our study shows that RAPN can be safely done for cT1b + renal tumours. These findings reinforce the view that RAPN should be considered a viable option for cT1b + lesions whenever technically feasible.