We aimed to compare the outcomes of open vs robotic partial nephrectomy (PN), focusing on predictors of Trifecta failure in patients with highly complex renal masses.
We queried the prospectively collected database from the SIB International Consortium, including 507 consecutive patients with cT1-2N0M0 renal masses treated at 16 high-volume referral centres, to select those with highly complex (PADUA score ≥10) tumors undergoing PN. RT was classified as enucleation, enucleoresection or resection according to the SIB score. Trifecta was defined as achievement of negative surgical margins, no acute kidney injury and no Clavien-Dindo grade ≥2 postoperative surgical complications. Multivariable logistic regression analysis was used to assess independent predictors of Trifecta failure.
113 patients were included. Patients undergoing open PN (n = 47, 41.6%) and robotic PN (n = 66, 58.4%) were comparable in baseline characteristics. RT was classified as enucleation, enucleoresection and resection in 46.9%, 34.0% and 19.1% of open PN, and in 50.0%, 40.9% and 9.1% of robotic PN (p = 0.28). Trifecta was achieved in significantly more patients after robotic PN (69.7% vs. 42.6%, p = 0.004). On multivariable analysis, surgical approach (open vs robotic, OR: 2.62; 95%CI: 1.11-6.15, p = 0.027) and tumor complexity (OR for each additional unit of the PADUA score: 2.27; 95%CI: 1.27-4.06, p = 0.006) were significant predictors of Trifecta failure, while RT was not. The study is limited by lack of randomization; as such, selection bias and confounding cannot be entirely ruled out.
Tumor complexity and surgical approach were independent predictors of Trifecta failure after PN for highly complex renal masses.
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2021 Nov 27 [Epub ahead of print]
Riccardo Campi, Fabrizio Di Maida, Brian R Lane, Ottavio De Cobelli, Francesco Sanguedolce, Georgios Hatzichristodoulou, Alessandro Antonelli, Sabrina Noyes, Andrea Mari, Antonio Andrea Grosso, Oscar Rodriguez-Faba, Frank X Keeley, Johan Langenhuijsen, Gennaro Musi, Tobias Klatte, Marco Roscigno, Bulent Akdogan, Maria Furlan, Nihat Karakoyunlu, Martin Marszalek, Umberto Capitanio, Alessandro Volpe, Sabine Brookman-May, Jürgen E Gschwend, Marc C Smaldone, Robert G Uzzo, Marco Carini, Alexander Kutikov, Andrea Minervini, Members of the SIB International Consortium
Department of Urology, University of Florence, Florence, Italy, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy., Department of Urology, Spectrum Health Medical Group, Grand Rapids, MI, USA., Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy., Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom; Uro-oncology Unit, Fundacio Puigvert, Barcelona, Spain., Department of Urology, Technical University of Munich, Rechts der Isar University Hospital, Munich, Germany; Department of Urology, Martha-Maria Hospital Nuremberg, Germany., Department of Urology, University of Brescia, Brescia, Italy; Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy., Uro-oncology Unit, Fundacio Puigvert, Barcelona, Spain., Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom., Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands., Department of Urology, Royal Bournemouth Hospital, Bournemouth, United Kingdom; Department of Urology, Medical University of Vienna, Vienna, Austria., Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy., Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey., Department of Urology, University of Brescia, Brescia, Italy., Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey., Department of Urology and Andrology, Donauspital, Austria; Department of Urology, Graz Medical University, Graz, Austria., Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy., Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy., Ludwig-Maximilians University (LMU) Munich, Campus Grosshadern, Dept. of Urology, Janssen Pharma Research and Development, Los Angeles, CA, USA., Department of Urology, Technical University of Munich, Rechts der Isar University Hospital, Munich, Germany., Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, USA., Department of Urology, University of Florence, Florence, Italy, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. Electronic address: .