Trifecta Outcomes in Multifocal Tumors: A Comparison Between Robotic and Open Partial Nephrectomy

Yerram, Nitin; Dagenais, Julien; Bryk, Darren J.; Nandanan, Naveen; Maurice, Matthew J.; Mouracadé, Pascal; Kara, Önder; Kaouk, Jihad

doi:10.1089/end.2018.0134

Cited by 17 publications

(17 citation statements)

References 29 publications

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“…As in our study, Yerram et al [15] found that achievement of the trifecta outcome (de ned as negative surgical margins, no urologic complications, and ≥ 90% eGFR preservation at last follow-up) was not different between OPN and RAPN. This may be explained by the fact that LPN is inferior to both surgical OPN and RAPN because of its more challenging surgical techniques.…”

Section: Discussionsupporting

confidence: 76%

“…As in our study, Zargar et al [20] found that the postoperative creatinine concentration and eGFR were not different between LPN and RAPN. Yerram et al [15] found that the proportion of patients with ≥ 90% eGFR preservation at follow-up was not different between OPN and RAPN.…”

Section: Discussionmentioning

confidence: 98%

“…The concept of the "trifecta" outcome has recently been used to evaluate surgical pro ciency and includes negative surgical margins, no severe surgical complications, and 90% preservation of the estimated glomerular ltration rate (eGFR) postoperatively [15]. However, the factors that affect the trifecta outcome are unclear.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Trifecta Outcome Among Open, Laparoscopic, and Robotic-Assisted Partial Nephrectomy in Patients With Small Renal Masses: 10-Year Experience in Ramathibodi Hospital

Soisrithong

Viseshsindh

Kongchareonsombat

et al. 2021

Preprint

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Purpose: To compare the trifecta outcome and perioperative and postoperative outcomes among open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robotic-assisted partial nephrectomy (RAPN) in patients with small renal masses in Ramathibodi Hospital.Methods: We retrospectively reviewed 141 patients who underwent partial nephrectomy from January 2009 to December 2018. The baseline characteristics and preoperative outcomes were compared among the three surgical approaches. Results: Among the 141 patients, 42 (29.79%), 29 (20.57%), and 70 (49.64%) patients underwent OPN, LPN, and RAPN, respectively. Among 116 patients with available data, 71 achieved the trifecta outcome [18 (56.25%), 14 (56.00%), and 39 (73.58%) in the OPN, LPN, and RAPN group, respectively; p=0.276]. The rate of conversion to OPN was higher in the LPN than RAPN group. The number of patients who received intraoperative packed red cells was lowest in the RAPN group. The estimated blood loss was significantly lower in the LPN group than OPN and RAPN groups (p=0.041). The operative time was shorter in the OPN group than LPN and RAPN groups (p<0.001). Multivariate analysis showed that the intraoperative complication rate was a predictive factor for trifecta outcome achievement.Conclusion: OPN had the shortest operative time. LPN had the highest rate of conversion to OPN and lowest estimated blood loss. The number of patients who received intraoperative packed red cells was lowest in the RAPN group. However, achievement of the trifecta outcome was not significantly different among the three groups. The predictive factor for trifecta outcome achievement was the intraoperative complication rate.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 98%

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Comparison of Trifecta Outcome Among Open, Laparoscopic, and Robotic-Assisted Partial Nephrectomy in Patients With Small Renal Masses: 10-Year Experience in Ramathibodi Hospital

Soisrithong

Viseshsindh

Kongchareonsombat

et al. 2021

Preprint

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“…Although there are several different definitions for trifecta in the literature, the main goals of the trifecta outcomes in terms of LPN are achieving negative surgical margin, minimizing postoperative complications and WIT (22). Besides the definition of a diverse trifecta criterion, the characteristics of the patients and the tumor included in the studies, the surgical technique used and the surgical experience might have resulted in reporting disparate success rates (23,24). Therefore, the trifecta outcomes indicated in the literature vary from 32% to 81% (25).…”

Section: Discussionmentioning

confidence: 99%

Comparison of functional outcomes of off-clamp laparoscopic partial nephrectomy access techniques: A preliminary report

Mercimek

Özden

2021

Int. braz j urol.

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Objective: This study aims to compare renal functional outcomes of access techniques in patients who underwent off-clamp (Off-C) laparoscopic partial nephrectomy (LPN). Materials and Methods: Thirty-four Off-C LPNs in patients with functioning contralateral kidney from March 2011 to June 2018 were included in the study. Twenty-two patients underwent transperitoneal, 12 patients underwent retroperitoneal Off-C LPN. The primary outcome was glomerular fi ltration rate changes over time, postoperatively. The secondary outcome was the evaluation of trifecta and pentafecta rate. Results: Preoperative demographics, tumor size (26.59 vs. 22.83mm, p=0.790), RENAL score (5.45 vs. 5.33, p=0.990), operation time (79.95 vs. 81.33 min, p=0.157), blood loss (170.23 vs. 150.83mL, p=0.790) were similar in both groups. Although preservation of renal function was better in group 2 in the early period, similar results were found in both groups at the end of the fi rst year, postoperatively. No positive surgical margin and postoperative major complications were detected in any patient. While trifecta goals were achieved in all the patients in the cohort, pentafecta rates were 90.9% and 91.7% in the transperitoneal and retroperitoneal groups, respectively. Conclusions: Transperitoneal and retroperitoneal access were found to have similar outcomes in terms of preservation of renal function at the end of the fi rst year postoperatively. Off-C LPN may be considered as a safe and effective treatment option in patients having non-complex renal tumors.

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“…Yerram et al. [ 12 ] compared the trifecta outcomes of 68 RAPN vs. 42 OPN in kidneys with multiple tumors. Trifecta was defined as negative surgical margins, no urologic complications, and a glomerular filtration rate (GFR) preservation of ≥90% at last follow-up.…”

Section: Pn In Complex Scenariosmentioning

confidence: 99%

Robotic renal and adrenal oncologic surgery: A contemporary review

Bhat

Moschovas

Önol

et al. 2021

Asian Journal of Urology

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Robot-assisted surgery has evolved over time. Radical nephrectomy with inferior vena cava thrombectomy is feasible and safe for level I, II and III thrombus in high volume centers. Though it is feasible for level IV thrombus, this procedure needs a multi-departmental co-operation. However, the safety of robot-assisted procedures in this subset is still unknown. Robot-assisted partial nephrectomy has been universally approved and found oncologically safe. Robotic adrenalectomy has been increasingly utilized for select cases, especially in bilateral tumors and for retroperitoneal adrenalectomy.

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Trifecta Outcomes in Multifocal Tumors: A Comparison Between Robotic and Open Partial Nephrectomy

Cited by 17 publications

References 29 publications

Comparison of Trifecta Outcome Among Open, Laparoscopic, and Robotic-Assisted Partial Nephrectomy in Patients With Small Renal Masses: 10-Year Experience in Ramathibodi Hospital

Comparison of Trifecta Outcome Among Open, Laparoscopic, and Robotic-Assisted Partial Nephrectomy in Patients With Small Renal Masses: 10-Year Experience in Ramathibodi Hospital

Comparison of functional outcomes of off-clamp laparoscopic partial nephrectomy access techniques: A preliminary report

Robotic renal and adrenal oncologic surgery: A contemporary review

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