Factors Associated With Trifecta and Pentafecta Achievement in Robot-Assisted Laparoscopic Partial Nephrectomy for
Hiroki Ishihara1, Koichi Nishimura2, Yuki Kobari1
1Department of Urology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
Background:
Robot-assisted laparoscopic partial nephrectomy (RAPN) for highly complex renal tumors can be challenging. However, determinants of oncological and functional outcomes after RAPN in this high-risk population remain poorly characterized.
Methods:
We retrospectively evaluated the clinical data of 396 consecutive patients who underwent RAPN for cT1N0M0 renal tumors of high complexity, defined as a RENAL nephrectomy score ≥ 10. Factors associated with trifecta (negative surgical margin, warm ischemic time ≤ 25 min, and no surgical complications) and pentafecta achievement (≥ 90% estimated glomerular filtration rate preservation and no chronic kidney disease stage upgrade at 1 year postoperatively, along with trifecta achievement) were investigated.
Results:
Trifecta was achieved in 201 patients (51%). Multivariable analysis showed that right-side tumors (p = 0.0217), non-hilar tumors (p = 0.0056), shorter operating times (p < 0.0001), and unexposed urinary systems (p = 0.0022) were independent factors for trifecta achievement. Among 334 patients with eligible data for pentafecta evaluation, 104 (31%) achieved pentafecta. After covariate adjustment, non-hilar tumors (p = 0.0449), shorter operating times (p = 0.0003), and unexposed urinary systems (p = 0.0004) were independent factors for pentafecta achievement.
Conclusion:
Factors associated with trifecta and pentafecta achievement after RAPN were identified for highly complex renal tumors. These perioperative factors may be utilized for postoperative outcome prediction after RAPN in this challenging population.