Trifecta and Pentafecta Rates After Robotic Assisted Partial Nephrectomy: Comparative Study of Patients with Renal Masses &lt;4 and ≥4 cm

Castellucci, Roberto; Primiceri, Giulia; Castellan, Pietro; Marchioni, Michele; D’Orta, Carlo; Berardinelli, Francesco; Neri, Fabio; Cindolo, Luca; Schips, Luigi

doi:10.1089/lap.2017.0657

Cited by 17 publications

(16 citation statements)

References 21 publications

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“…A multicentre study assessing 1222 RAPN found tumour size (p < 0.001) and hospital case volume (p = 0.005) to be the factors that most influenced trifecta achievement [23], whilst an assessment of 277 RAPN cases found R.E.N.A.L nephrometry scoring to be a significant predictor of achieving pentafecta outcome [19]. In our series, both tumour size (p = 0.980) and nephrometry scores (p = 0.880) were considered to be statistically insignificant, which is supported by other series [24][25][26]. Stroup et al identified no statistically significant difference in surgical approach either with pentafecta outcome (p = 0.526), although the approach was based on technical considerations, rather than in a randomised fashion.…”

Section: Discussionsupporting

confidence: 80%

“…Generally, our reported rates of pentafecta achievement are superior to those in the literature, although these aren't propensity-matched patients to allow for a fair comparison. From a technical standpoint along with aiming to adhere to surgical principles of shorter surgical time, low WIT, T1a = 38% T1b 27% Stroup et al [24] 2017 404 Retroperitoneal (2.9 cm) Transperitoneal (3.1 cm) Retroperitoneal = 43% Transperitoneal = 34% Kang et al [25] 2017 362 2.9 cm 34% Castelluci et al [26] 2019 123 < 4 cm/> 4 cm cohorts < 4 cm = 23%; > 4 cm = 11% Current study 2019 224 2.9 cm 54% minimise blood loss, we work closely with our anaesthetic team to ensure good intra and post-operative hydration of our RAPN patients, supplemented with pre-clamping Mannitol instillation to ensure a well-perfused kidney prior to subjecting it to any ischaemic insult. This may be contributory to the good functional outcomes that we have demonstrated in our study.…”

Section: Discussionmentioning

confidence: 99%

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Robotic-assisted partial nephrectomy (RAPN) and standardization of outcome reporting: a prospective, observational study on reaching the “Trifecta and Pentafecta”

et al. 2020

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Partial nephrectomy (PN) for small renal masses is common, but outcomes are not reported in a standard manner. Traditionally, parameters such as 90-day mortality, blood loss, transfusion rates, length of stay, nephrometry scoring and complications are published but their collective impact on warm ischemia time (WIT) and post-surgery GFR is rarely determined. Thus, our aim was to assess if “Trifecta” and “Pentafecta” outcomes could be used as useful surgical outcome markers. A prospective database of 252 Robotic-Assisted PN (RAPN) cases (2008–2019) was analysed. “Pentafecta” was defined as achievement of “Trifecta” (negative surgical margin, no postoperative complications and WIT of < 25 min) plus over 90% estimated GFR preservation and no CKD stage upgrading at 1 year. Binary logistic regression analysis was conducted to predict factors which may prevent achieving a Trifecta/Pentafecta. Median tumour size was 3 cm and mean WIT was 15 min. Positive surgical margins (PSM) occurred in 2 cases. Overall, the intra-operative complication rate was 7%. One recurrence conferred 5-year cancer-free survival of 97%. Trifecta outcome was achieved in 169 (67%) and Pentafecta in 141 (56%) of cases. At logistic regression analysis, intraoperative blood loss was the only factor to affect Trifecta achievement (p = 0.018). Advanced patient age negatively impacted Pentafecta achievement (p = 0.010). The Trifecta and Pentafecta outcomes are easily applicable to PN data, and offer an internationally comparable PN outcome, quality measure. We recommend applying this standardization to national data collection to improve the quality of reporting and ease of interpretation of surgeon/centres’ outcomes.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Robotic-assisted partial nephrectomy (RAPN) and standardization of outcome reporting: a prospective, observational study on reaching the “Trifecta and Pentafecta”

et al. 2020

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“…In Table 3, we present the TRIFECTA achievement rates reported for previous series of approximately 100 cases (18)(19)(20)(21)(22). Previously, the hospital and surgeon volumes were identified as factors that strongly influenced the achievement of TRIFECTA during RAPN (23).…”

Section: Discussionmentioning

confidence: 99%

Utilization of a three-dimensional printed kidney model for favorable TRIFECTA achievement in early experience of robot-assisted partial nephrectomy

et al. 2020

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Background: This retrospective study aimed to investigate whether a three-dimensional (3D) model would improve the achievement of TRIFECTA, which was defined as the absence of perioperative complications and positive surgical margins and a warm ischemia time of <25 minutes, during robot-assisted partial nephrectomy (RAPN). Methods: Prior to RAPN, a 3D-square type kidney model was prepared and used for all RAPN procedures in patients with T1a renal cell carcinoma (RCC) treated at a single center between March 2016 and April 2019. All RAPN procedures were performed by a single surgeon. Results: The study included 50 patients, of whom 22, 24, and 4 had low-, intermediate-, and high-risk R.E.N.A.L Nephrometry scores, respectively. The TRIFECTA achievement rate was 86.0%, and transfusion or conversion to radical nephrectomy was not required in any of the patients. Only one Clavien-Dindo grade 3 complication was reported-a pseudoaneurysm that required embolism. The TRIFECTA achievement rate was independent of the R.E.N.A.L Nephrometry scores and the surgeon's experience level (25 cases each of early and advanced experience).Conclusions: The 3D model contributed to the achievement of TRIFECTA during RAPN performed by a less-experienced surgeon. These findings should be further evaluated in studies involving a larger number of cases and surgeons.

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“…In addition, our study did not measure success of PN using the concepts of trifecta and pentafecta; these are the most common methods for assessing both short-and long-term PN success. This was mostly due to missing data and loss of follow-up in our study population (24).…”

Section: Limitationsmentioning

confidence: 94%

Partial Nephrectomy A Comparison between Different Modalities

Asker

Addar

Alghamdi

et al. 2021

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Kidney cancer, with 4% of all malignancies, is one of the most common malignancies occurring among in adults. In Saudi Arabia, kidney cancer comprises 2.3% of all cancers, and its incidence has increased by 33%. Partial nephrectomy (PN) is considered as the gold standard for T1 renal masses.In this retrospective study, we did a chart review for all patients who underwent PNs between April 2013 and February 2019. Data comprised pre-sentation, tumor size, type of procedure (open vs. laparoscopic vs. robotic), and intra- and post-operative complications. Chi-square, ANOVA, and cross-tabulation were done using SPSS software. P > 0.05 was considered significant. Approval was obtained from the institutional review board of King Abdullah International Medical Research Center.In all, 69 patients were identified: 26 (37.7%) males and 43 (62.3%) females, with mean age = 54.53 ± 13.21 years; mean body mass index = 32.36 ± 7.03, and mean tumor size = 3.7 ± 1.72 cm. In terms of presentation, most patients (50, 72.4%) presented incidentally as opposed to symptomatic presentation. Of these patients, 18 (26.1%) underwent open partial nephrectomy (OPN), 29 (42%) laparoscopic partial nephrec-tomy (LPN), and 22 (31.9%) robotic partial nephrectomy (RPN). On comparing minimally invasive surgery (MIS) PN with OPN, we found that OPN had more blood loss and a longer hospital stay but a shorter operating room (OR) time.Results of PN irrespective of the procedure type, whether it was OPN, LPN, or RPN, were similar if performed by experienced surgeons. However, open procedures involved a higher blood loss, more operative time, and longer hospital stay when compared with minimally invasive techniques.

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Trifecta and Pentafecta Rates After Robotic Assisted Partial Nephrectomy: Comparative Study of Patients with Renal Masses <4 and ≥4 cm

Abstract: RAPN may be considered a feasible and safe surgical approach ensuring good functional outcome even for patients with RMs ≥4 cm. Pentafecta rates after RAPN were comparable between RMs <4 and ≥4 cm in diameter.

Cited by 17 publications

References 21 publications

Robotic-assisted partial nephrectomy (RAPN) and standardization of outcome reporting: a prospective, observational study on reaching the “Trifecta and Pentafecta”

Robotic-assisted partial nephrectomy (RAPN) and standardization of outcome reporting: a prospective, observational study on reaching the “Trifecta and Pentafecta”

Utilization of a three-dimensional printed kidney model for favorable TRIFECTA achievement in early experience of robot-assisted partial nephrectomy

Partial Nephrectomy A Comparison between Different Modalities

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