Lorenzo Bianchi1,2, Riccardo Schiavina3,4, Marco Borghesi3,4, Francesco Chessa3,4, Carlo Casablanca3, Andrea Angiolini3, Amelio Ercolino3, Cristian V Pultrone3,4, Federico Mineo Bianchi3, Umberto Barbaresi3, Pietro Piazza3, Fabio Manferrari3,4, Alessandro Bertaccini3,4, Michelangelo Fiorentino5, Matteo Ferro6, Angelo Porreca7, Emanuela Marcelli4,5,6,7,8, Eugenio Brunocilla3,4. 1. Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy - lorenzo.bianchi3@gmail.com. 2. Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy - lorenzo.bianchi3@gmail.com. 3. Department of Urology, Sant'Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy. 4. Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy. 5. Laboratory of Oncologic Molecular Pathology, Sant'Orsola-Malpighi Teaching Hospital, University of Bologna, Bologna, Italy. 6. Istituto Europeo di Urologia, Milan, Italy. 7. Department of Urology, Abano Terme Hospital, Padua, Italy. 8. Laboratory of Bioengineering, Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy.
Abstract
BACKGROUND: To develop a clinical nomogram aimed to predict the achievement of trifecta in patients treated with open, laparoscopic and robotic partial nephrectomy (PN) for localized renal masses (<cT2). METHODS: We retrospectively evaluated 482 consecutive patients who underwent PN with open (OPN: 243), laparoscopic (LPN: 156) and robotic (RAPN: 83) approach for T1 renal mass at single tertiary center. Trifecta was defined as follows: warm ischemia time (WIT) <20 min and no positive surgical margins (PSM) and no postoperative complications. First, we compared clinical, pathologic and perioperative outcomes within the three surgical approaches. Second, multivariable logistic regression was performed to identify the independent predictors of the trifecta's achievement. Finally, regression-based coefficients were used to develop a nomogram predicting the likelihood to achieve the trifecta and 200 bootstrap resamples were used for internal validation. RESULTS: The three cohorts were comparable in terms of demographics and clinical characteristics. Trifecta has been achieved in 49%, 50.6% and 69.9% of patients undergoing OPN, LPN and RAPN, respectively (P=0.003). At multivariable analyses, American Anesthesiologists Score (ASA) score 3-4 (Odd Ratio [OR]: 0.63; P=0.02), urinary collecting system (UCS) involvement (OR 0.56; P=0.02) and surgical approach (LPN and OPN vs. RAPN: OR: 0.39 and 0.38, respectively; P=0.001) were independent predictors of trifecta's achievement. A nomogram based on covariates included in the multivariable model demonstrated bootstrap-corrected predictive accuracy of 63%. CONCLUSIONS: ASA Score, UCS involvement and the surgical technique were independent predictors of trifecta outcome. Our nomogram could facilitate the preoperative counselling and to choose the best surgical approach for PN.
BACKGROUND: To develop a clinical nomogram aimed to predict the achievement of trifecta in patients treated with open, laparoscopic and robotic partial nephrectomy (PN) for localized renal masses (<cT2). METHODS: We retrospectively evaluated 482 consecutive patients who underwent PN with open (OPN: 243), laparoscopic (LPN: 156) and robotic (RAPN: 83) approach for T1 renal mass at single tertiary center. Trifecta was defined as follows: warm ischemia time (WIT) <20 min and no positive surgical margins (PSM) and no postoperative complications. First, we compared clinical, pathologic and perioperative outcomes within the three surgical approaches. Second, multivariable logistic regression was performed to identify the independent predictors of the trifecta's achievement. Finally, regression-based coefficients were used to develop a nomogram predicting the likelihood to achieve the trifecta and 200 bootstrap resamples were used for internal validation. RESULTS: The three cohorts were comparable in terms of demographics and clinical characteristics. Trifecta has been achieved in 49%, 50.6% and 69.9% of patients undergoing OPN, LPN and RAPN, respectively (P=0.003). At multivariable analyses, American Anesthesiologists Score (ASA) score 3-4 (Odd Ratio [OR]: 0.63; P=0.02), urinary collecting system (UCS) involvement (OR 0.56; P=0.02) and surgical approach (LPN and OPN vs. RAPN: OR: 0.39 and 0.38, respectively; P=0.001) were independent predictors of trifecta's achievement. A nomogram based on covariates included in the multivariable model demonstrated bootstrap-corrected predictive accuracy of 63%. CONCLUSIONS: ASA Score, UCS involvement and the surgical technique were independent predictors of trifecta outcome. Our nomogram could facilitate the preoperative counselling and to choose the best surgical approach for PN.
Authors: Stefano Puliatti; Ahmed Eissa; Enrico Checcucci; Pietro Piazza; Marco Amato; Stefania Ferretti; Simone Scarcella; Juan Gomez Rivas; Mark Taratkin; Josè Marenco; Ines Belenchon Rivero; Karl-Friedrich Kowalewski; Giovanni Cacciamani; Ahmed El-Sherbiny; Ahmed Zoeir; Abdelhamid M El-Bahnasy; Ruben De Groote; Alexandre Mottrie; Salvatore Micali Journal: Asian J Urol Date: 2022-06-01
Authors: Alberto Piana; Iulia Andras; Pietro Diana; Paolo Verri; Andrea Gallioli; Riccardo Campi; Thomas Prudhomme; Vital Hevia; Romain Boissier; Alberto Breda; Angelo Territo Journal: Asian J Urol Date: 2022-06-10