Samrad Ghavimi1, Olli Saarela2, Frederic Pouliot3, Ricardo A Rendon4, Antonio Finelli2, Anil Kapoor5, Ronald B Moore6, Rodney H Breau7, Luke Lavallee7, Louis Lacombe3, Adrian Fairey6, Michael Jewett2, Zhihui Liu2, Simon Tanguay8, Peter C Black9. 1. University of British Columbia, Level 6, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. 2. University of Toronto, 610 University Avenue Toronto, Toronto, ON, M5G 2M9, Canada. 3. L'Hôtel-Dieu de Québec, 6 rue McMahon 0624, Quebec City, QC, G1R 2J6, Canada. 4. Dalhousie University, VG Site-5th Floor Centennial Room 5015, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada. 5. McMaster University, 50 Charlton Ave E, Room G344, Hamilton, ON, L8N 4A6, Canada. 6. Kaye Edmonton Clinic, University of Alberta, 11400 University Avenue, 7th Floor, Edmonton, AB, T6G 1Z1, Canada. 7. University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. 8. McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada. 9. University of British Columbia, Level 6, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. pblack@mail.ubc.ca.
Abstract
INTRODUCTION: The "trifecta" is a summary measure of outcome after partial nephrectomy (PN) that encompasses three parameters: negative surgical margin, ≤ 10% decrease in post-operative estimated glomerular filtration rate (eGFR) and absence of urological complications. We assessed trifecta rates in patients undergoing open (OPN), laparoscopic (LPN), and robotic PN (RPN) for a clinical T1 renal mass (≤ 7 cm). METHODS: Clinical and pathologic parameters were extracted from the prospectively maintained Canadian Kidney Cancer Information System for patients treated between January 2011 and October 2018. Comparisons between groups were made using Kruskal-Wallis test for continuous variables and Chi-squared independence test for categorical variables. Multivariable analysis was performed to identify predictors of each component of the trifecta and the trifecta itself. RESULTS: Of 1708 total patients, 746 underwent OPN, 678 LPN, and 284 RPN for a T1 renal mass. A 'trifecta' was achieved in 53% OPN, 52% LPN and 47% RPN (p = 0.194). On multivariable analysis, OPN and LPN were associated with less frequent post-operative decline in eGFR and more frequent trifecta when compared to RPN, but there was no difference between OPN and LPN. OPN also predicted a higher rate of negative margins compared to RPN but not LPN. CONCLUSION: After correction for confounding variables, OPN and LPN were more likely than RPN to achieve the trifecta, which appeared to be due primarily to loss of renal function. No difference was observed between OPN and LPN. Analyses were limited by the lack of nephrometry score.
INTRODUCTION: The "trifecta" is a summary measure of outcome after partial nephrectomy (PN) that encompasses three parameters: negative surgical margin, ≤ 10% decrease in post-operative estimated glomerular filtration rate (eGFR) and absence of urological complications. We assessed trifecta rates in patients undergoing open (OPN), laparoscopic (LPN), and robotic PN (RPN) for a clinical T1 renal mass (≤ 7 cm). METHODS: Clinical and pathologic parameters were extracted from the prospectively maintained Canadian Kidney Cancer Information System for patients treated between January 2011 and October 2018. Comparisons between groups were made using Kruskal-Wallis test for continuous variables and Chi-squared independence test for categorical variables. Multivariable analysis was performed to identify predictors of each component of the trifecta and the trifecta itself. RESULTS: Of 1708 total patients, 746 underwent OPN, 678 LPN, and 284 RPN for a T1 renal mass. A 'trifecta' was achieved in 53% OPN, 52% LPN and 47% RPN (p = 0.194). On multivariable analysis, OPN and LPN were associated with less frequent post-operative decline in eGFR and more frequent trifecta when compared to RPN, but there was no difference between OPN and LPN. OPN also predicted a higher rate of negative margins compared to RPN but not LPN. CONCLUSION: After correction for confounding variables, OPN and LPN were more likely than RPN to achieve the trifecta, which appeared to be due primarily to loss of renal function. No difference was observed between OPN and LPN. Analyses were limited by the lack of nephrometry score.
Entities:
Keywords:
Minimally invasive versus open; Partial nephrectomy; Trifecta