Predicting Strict Trifecta Outcomes after Robot-Assisted Partial Nephrectomy: Comparison of RENAL, PADUA, and C-Index Scores

Abstract

Nephrometry scores are designed to characterize tumors and stratify the surgical complexity. It remains unclear as to which nephrometry score can accurately predict the surgical outcomes. We aimed to assess the utility of radius, exophytic/endophytic, nearness, anterior/posterior, location (RENAL), preoperative aspects and dimensions used for anatomic classifications (PADUA), and centrality index (C-index) nephrometry scores for predicting the strict Trifecta achievement from a single institution series robotic-assisted partial nephrectomy (RAPN). We retrospectively identified the prospectively maintained robotic surgery database records of 91 patients who underwent RAPN between June 2015 and September 2020 in Antalya Training and Research Hospital. The main outcome of the study was the achievement of strict Trifecta (negative surgical margin, no major urologic complications, warm ischemia time ≤25 min, and ≥85% preservation of estimated glomerular filtration rate). A mul-tivariable analysis was performed to identify the factors of strict Trifecta success. The mean patient age was 55.82 ± 13.37 years with a median clinical tumor size of 3.5 cm (IQR 2.5–4.9). The median RENAL, PADUA, and C-index score were 7(IQR 6–8), 8(IQR 7–10), and 2.01(IQR 1.64–2.72), respectively. A strict Trifecta could be achieved in 54 patients (59.3%). Clinical tumor size (P = 0.011), RENAL risk groups (low:ref-erence; intermediate; P = 0.040; high; P = 0.009), PADUA risk groups (low:reference; intermediate; P = 0.044; high; P = 0.001) and C-index risk groups (low:reference; high; P = 0.015) were the independent predictors of strict Trifecta attainment in the multivariate analysis. None of the nephrometry scores were a superior predictor compared to other nephrometry scores in comparative analysis. RENAL, PADUA, and C-index scores were all independent predictors of a strict Trifecta achievement. Our comprehensive comparison of the three scores identified that none of the nephrometry scores proved to be inferior to others nephrometry scores.

Nephrometry scoring systems RENAL, PADUA, C-index, SPARE, and ZONAL NePhRO for prediction of partial nephrectomy outcomes

“…в исследовании изучили возможность предсказания шкал RENAL, PADUA и C-index для достижения трифекты у 91 пациента, перенесшего роботическую резекцию опухоли почки. Все шкалы показали хорошую предиктивность достижения трифекты и были независимы друг от друга (площади под кривой (AUC) для RENAL, PADUA и C-index составили 0,782, 0,838 и 0,828 соответственно), а также ни одна шкала по своей результативности не уступала остальным [17].…”

Best predictive single nephrometry score component to correlate with achievement of trifecta outcome in laparoscopic and robotic surgery

“…In addition, multiple studies have analyzed the relationship between surgical approach and trifecta outcome [ 4 , 8 , 10 , 26 ]. In a direct comparison between open and robotic PN, Campi et al found that robotic PN was a significant predictor for achieving trifecta outcomes [ 27 ].…”

“…nephrometry score is an established anatomical system for categorizing complexity of renal tumors prior to surgery. Multiple studies have shown Nephrometry scores strongly correlate with effective PN [ 2 – 5 ] and predicts the attaining of “trifecta outcome” (reduced global renal ischemia, minimal complications, and high rates of negative margins) [ 4 , 6 ]. Herein, we evaluate the predictive value of individual components of the R.E.N.A.L scoring system for Laparoscopic (LPN) and Robotic Partial Nephrectomy (RPN).…”

Trifecta and pentafecta outcomes following robot-assisted partial nephrectomy in a multi-institutional cohort of Indian patients

“…[ 4 16 20 22 ] Numerous studies have identified predictors of trifecta outcomes in relation to different surgical modalities and patient populations. Perioperative variables such as tumor size,[ 23 24 25 26 27 28 29 ] nephrometry scores (RNS,[ 27 30 31 ] PADUA score,[ 27 28 29 ] C-Index,[ 27 ] Simplified PADUA REnal [SPARE][ 32 ]), surgical approach,[ 23 33 ] pelvicalyceal system involvement,[ 23 ] hospital volume,[ 34 ] hilar location,[ 16 24 ] intraoperative blood loss,[ 24 28 35 ] and the American Society of Anesthesiologists grading[ 23 ] have been identified as independent predictors of the trifecta. However, apart from tumor complexity, none of the other factors have been consistently shown to predict these outcomes.…”