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.
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.
Authors: Michele Marchioni; Petros Sountoulides; Maria Furlan; Maria Carmen Mir; Lucia Aretano; Jose Rubio-Briones; Mario Alvarez-Maestro; Marta Di Nicola; Alfredo Aguilera Bazán; Alessandro Antonelli; Claudio Simeone; Luigi Schips Journal: Int Urol Nephrol Date: 2021-08-21 Impact factor: 2.370
Authors: Rocco Simone Flammia; Umberto Anceschi; Antonio Tufano; Gabriele Tuderti; Maria Consiglia Ferriero; Aldo Brassetti; Andrea Mari; Fabrizio Di Maida; Andrea Minervini; Ithaar H Derweesh; Umberto Capitanio; Alessandro Larcher; Francesco Montorsi; Daniel D Eun; Jennifer Lee; Lorenzo G Luciani; Tommaso Cai; Gianni Malossini; Alessandro Veccia; Riccardo Autorino; Cristian Fiori; Francesco Porpiglia; Michele Gallucci; Costantino Leonardo; Giuseppe Simone Journal: J Clin Med Date: 2022-02-25 Impact factor: 4.241
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