Trifecta Outcomes in Open, Laparoscopy or Robotic Partial Nephrectomy: Does the Surgical Approach Matter?

Abstract

This retrospective study evaluated perioperative outcomes of open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robot-assisted partial nephrectomy (RAPN) and identified predictive factors of Trifecta achievement for renal tumors that underwent partial nephrectomy (PN) in a single institutional cohort. The study involved patients who underwent PN from January 2011 to July 2018. Trifecta was defined as absence of perioperative complications, no positive surgical margins, and ischemia time <30 min. Fifty-five PN procedures were reviewed: 28 OPN, 14 LPN, and 13 RAPN. OPN, LPN and RAPN had similar median tumor size (5.75, 5.25, and 5 cm), nephrometry score (7, 6, and 6), and preoperative creatinine (1.09, 1.1, and 1.1 mg/dl, respectively). Blood loss was higher for OPN (550 ml) than for LPN (400 ml) and RAPN (300 ml), P = 0.042. Drain was removed after 6 days in OPN which was higher than LPN and RAPN (4.5 and 4 days, respectively), P = 0.008. OPN, LPN, and RAPN had similar median operative time (190, 180, and 180 min, respectively), P = 0.438. Median postoperative stay for OPN, LPN, and RAPN was 5, 6.5, and 10 days, respectively. Trifecta outcomes of 73.1%, 64.3%, and 61.53% were achieved in OPN, LPN, and RAPN, respectively, P = 0.730. It was concluded that Trifecta outcomes had no significant difference among OPN, LPN, and RAPN. LPN can produce as good results as RAPN. Keeping in mind the cost-effectiveness, LPN holds an important position in developing countries where expenditure by patient is a major factor.

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

“…As in our study, Mehra et al [16] found that blood loss was lowest in the RAPN group (OPN > LPN > RAPN, p = 0.042). This can be explained by better visualization of the anatomy and movement control of instruments in RAPN.…”

“…As in our study, Mehra et al [16] found that the operative time was not different among the three groups.…”

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

“…In this context, the concepts of trifecta and pentafecta, which are commonly used to evaluate the outcomes of LPN, are utilized. 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).…”

Robotic renal and adrenal oncologic surgery: A contemporary review

“…Over time, however trifecta outcomes have shown a wide range of variation not only because of normal differences in surgical expertise and volume, but also because many changes have been made to the original definition. This entirely affects the comparison of success across the contemporary series with some studies, including a warm ischemia time (WIT) ranging over 25 min or 30 min, complications over Clavien 2 or 3, or reductions up to 30% in postoperative eGFR [ 4 , 5 ]. Another important effort in standardization is the development of nephrometry scores, which aim to objectively classify the complexity of a renal mass and to predict the possibility of postoperative complications.…”