TY - JOUR
T1 - Surgical quality, cancer control and functional preservation
T2 - introducing a novel trifecta for robot-assisted partial nephrectomy
AU - Brassetti, Aldo
AU - Anceschi, Umberto
AU - Bertolo, Riccardo
AU - Ferriero, Mariaconsiglia
AU - Tuderti, Gabriele
AU - Capitanio, Umberto
AU - Larcher, Alessandro
AU - Garisto, Juan
AU - Antonelli, Alessandro
AU - Mottire, Alexander
AU - Minervini, Andrea
AU - Dell'oglio, Paolo
AU - Veccia, Alessandro
AU - Amparore, Daniele
AU - Flammia, Rocco S
AU - Mari, Andrea
AU - Porpiglia, Francesco
AU - Montorsi, Francesco
AU - Kaouk, Jihad
AU - Autorino, Riccardo
AU - Carini, Marco
AU - Gallucci, Michele
AU - Simone, Giuseppe
PY - 2020/2
Y1 - 2020/2
N2 - BACKGROUND: In order to improve standard reporting of outcomes after partial nephrectomy, different "trifecta" systems have been conceived. The subjective assessment of the included parameters and the unreliability for off-clamp procedures limited their reproducibility; their role in predicting functional and oncologic outcomes has never been assessed. We propose a new trifecta, based on standardized parameters, that summarizes PN outcomes regardless the clamping technique used and predicts main clinical outcomes.METHODS: A retrospective analysis of a multicenter, multi-national dataset of patients with non-metastatic cT1-2 renal masses undergoing Robot-assisted partial nephrectomy was performed. Baseline demographic, clinical, pathologic and perioperative data were collected. Trifecta was defined as the coexistence of negative margins, no Clavien-Dindo ≥3 complications and ≤30% postoperative estimated glomerular filtration rate reduction. Univariable and multivariable regression analyses identified predictors of trifecta achievement. Kaplan-Meier method assessed differences in oncological outcomes between patients achieving trifecta or not. Univariable and multivariable Cox regression analysis identified predictors of newly onset chronic kidney disease stage ≥IIIa, recurrence-free and overall survival.RESULTS: Overall, 1492 patients achieved trifecta. This cohort displayed significantly lower incidence of newly onset IIIa-V chronic kidney disease stages (all P<0.001), higher recurrence-free (P=0.009) and overall (P=0.014) survival probabilities. Patients achieving trifecta had a 65% reduced risk of developing newly onset stage IIIb-V Chronic Kidney Disease and a 55% reduced risk of overall mortality. Heterogeneity of surgical technique is a limitation.CONCLUSIONS: This novel reproducible trifecta is based on standardized parameters and is an independent predictor of severe chronic kidney disease development and mortality.
AB - BACKGROUND: In order to improve standard reporting of outcomes after partial nephrectomy, different "trifecta" systems have been conceived. The subjective assessment of the included parameters and the unreliability for off-clamp procedures limited their reproducibility; their role in predicting functional and oncologic outcomes has never been assessed. We propose a new trifecta, based on standardized parameters, that summarizes PN outcomes regardless the clamping technique used and predicts main clinical outcomes.METHODS: A retrospective analysis of a multicenter, multi-national dataset of patients with non-metastatic cT1-2 renal masses undergoing Robot-assisted partial nephrectomy was performed. Baseline demographic, clinical, pathologic and perioperative data were collected. Trifecta was defined as the coexistence of negative margins, no Clavien-Dindo ≥3 complications and ≤30% postoperative estimated glomerular filtration rate reduction. Univariable and multivariable regression analyses identified predictors of trifecta achievement. Kaplan-Meier method assessed differences in oncological outcomes between patients achieving trifecta or not. Univariable and multivariable Cox regression analysis identified predictors of newly onset chronic kidney disease stage ≥IIIa, recurrence-free and overall survival.RESULTS: Overall, 1492 patients achieved trifecta. This cohort displayed significantly lower incidence of newly onset IIIa-V chronic kidney disease stages (all P<0.001), higher recurrence-free (P=0.009) and overall (P=0.014) survival probabilities. Patients achieving trifecta had a 65% reduced risk of developing newly onset stage IIIb-V Chronic Kidney Disease and a 55% reduced risk of overall mortality. Heterogeneity of surgical technique is a limitation.CONCLUSIONS: This novel reproducible trifecta is based on standardized parameters and is an independent predictor of severe chronic kidney disease development and mortality.
KW - Adult
KW - Aged
KW - Constriction
KW - Databases, Factual
KW - Female
KW - Glomerular Filtration Rate
KW - Humans
KW - Kidney Neoplasms/surgery
KW - Male
KW - Margins of Excision
KW - Middle Aged
KW - Nephrectomy/methods
KW - Postoperative Complications/epidemiology
KW - Recovery of Function
KW - Renal Insufficiency, Chronic/etiology
KW - Retrospective Studies
KW - Robotic Surgical Procedures/methods
KW - Survival Analysis
KW - Treatment Outcome
U2 - 10.23736/S0393-2249.19.03570-7
DO - 10.23736/S0393-2249.19.03570-7
M3 - Article
C2 - 31833720
VL - 72
SP - 82
EP - 90
JO - Minerva Urologica e Nefrologica
JF - Minerva Urologica e Nefrologica
SN - 0393-2249
IS - 1
ER -