Comparison of Trifecta and Pentafecta Outcomes between T1a and T1b Renal Masses following Robot-Assisted Partial Nephrectomy (RAPN) with Minimum One Year Follow Up: Can RAPN for T1b Renal Masses Be Feasible?

Abstract

Purpose/ObjectivesTo investigate the feasibility of RAPN on T1b renal mass by assessment of Trifecta and Pentafecta rate between T1a and T1b renal mass.Materials/MethodsWe retrospectively reviewed the medical records of 277 cases of RPN performed from 2006 to 2015. Sixty patients with clinically T1b renal masses (> 4cm and ≤ 7 cm) were identified, and from 180 patients with clinically T1a renal mass, 60 patients were matched with T1b renal mass by propensity score. Tumor complexity was investigated according to R.E.N.A.L nephrometry score. “Pentafecta” was defined as achievement of Trifecta (negative surgical margin, no postoperative complications and warm ischemia time of ≤ 25 minutes) with addition of over 90% estimated GFR preservation and no chronic kidney disease stage upgrading at 1 year postoperative period. Propensity score matching was performed by OneToManyMTCH. Logistic regression models were used to identify the variables which predict the Trifecta, and Pentafecta ac.ResultsPreoperative variables (age, sex, body mass index, ASA score) were similar between T1a and T1b after propensity score matching. The median R.E.N.A.L. nephrometry score was 8 vs 9 for T1a and T1b respectively (p<0.001). The median warm ischemia time was 20.1 min vs 26.2 min (p<0.001). Positive surgical margin rate was 5% vs 6.6% (p = 0.729) and overall complication rate of 13.3%. vs 15% (p = 0.793). The rate of achievement of Trifecta rate were 65.3% vs 43.3% (p = 0.017) and Pentafecta rate were 38.3% vs 26.7% (p = 0.172). For achievement of Pentafecta, R.E.N.A.L nephrometry score (HR 0.80; 95% CI (0.67–0.97); p = 0.031) was significant predictor of achieving Pentafecta. Subanalyis to assess the component of R.E.N.A.L nephrometry score, L component (location relative to the polar lines, HR 0.63; 95% CI (0.38–1.03); P = 0.064) was relatively important component for Pentafecta achievement.ConclusionsThe rate of Pentafecta after RAPN was comparable between T1a and T1b renal masses. RAPN is a feasible modality with excellent long term outcome for patients with larger renal mass (cT1b).

Optimum outcome achievement in partial nephrectomy for T1 renal masses: a contemporary analysis of open and robot‐assisted cases

“…The principal factor driving this seemingly ‘low’ rate of optimum outcome achievement is our renal function outcome, which is more stringent than other composite outcomes because it is based on GFR preservation and CKD upstaging instead of ischaemia time alone; however, when critically compared, our results are similar to those found in the literature. For example, in an analysis of RAPN outcomes for T1a and T1b renal masses of similar size and complexity to those included in the present study, Kim et al reported trifecta achievement rates of 65% and 43% for T1a and T1b masses, respectively, which are similar to our reported RAPN rates of 66% and 40%. In a multicentre study of RAPN for small renal masses, Zargar et al reported trifecta and pentafecta rates of 70% and 39%, respectively, which are slighlty better than our RAPN rates for T1a masses (66% and 28%); however, the larger size of masses in the present cohort may account for this difference .…”

Robot-Assisted Partial Nephrectomy for T1b Tumors: Strict Trifecta Outcomes

“…Kim et al 7 and Porpiglia et al 8 reported Trifecta outcomes in 43and 69.5% of robot-assisted surgical T1b patients, respectively. In both of these studies WIT ≤ 25 minutes was used for evaluation of renal function preservation.…”

Comparison by Pentafecta Criteria of Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy for Large Renal Tumors

“…Kim and colleagues retrospectively analyzed 277 patients of renal cell carcinoma undergoing RPN and reported 38.3% of Pentafecta achievement for T1a patients and 26.7% for T1b patients. 19 Our study also analyzed patients with ‡4 cm renal tumors. Rates of Pentafecta achievement for patients with ‡4 cm renal tumors decreased to 25.0% in patients receiving TRPN and 16.1% for patients receiving RRPN.…”