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Achieving the “trifecta” with open versus minimally invasive partial nephrectomy

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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.

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Acknowledgements

The authors would like to thank the Kidney Cancer Research Network of Canada for their contribution.

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Authors and Affiliations

  1. University of British Columbia, Level 6, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada

    Samrad Ghavimi & Peter C. Black

  2. University of Toronto, 610 University Avenue Toronto, Toronto, ON, M5G 2M9, Canada

    Olli Saarela, Antonio Finelli, Michael Jewett & Zhihui Liu

  3. L’Hôtel-Dieu de Québec, 6 rue McMahon 0624, Quebec City, QC, G1R 2J6, Canada

    Frederic Pouliot & Louis Lacombe

  4. Dalhousie University, VG Site-5th Floor Centennial Room 5015, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada

    Ricardo A. Rendon

  5. McMaster University, 50 Charlton Ave E, Room G344, Hamilton, ON, L8N 4A6, Canada

    Anil Kapoor

  6. Kaye Edmonton Clinic, University of Alberta, 11400 University Avenue, 7th Floor, Edmonton, AB, T6G 1Z1, Canada

    Ronald B. Moore & Adrian Fairey

  7. University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada

    Rodney H. Breau & Luke Lavallee

  8. McGill University, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada

    Simon Tanguay

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  1. Samrad Ghavimi
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  2. Olli Saarela
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  3. Frederic Pouliot
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  5. Antonio Finelli
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  6. Anil Kapoor
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  7. Ronald B. Moore
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  9. Luke Lavallee
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  10. Louis Lacombe
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  11. Adrian Fairey
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  12. Michael Jewett
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  13. Zhihui Liu
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  14. Simon Tanguay
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  15. Peter C. Black
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Correspondence to Peter C. Black.

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Ghavimi, S., Saarela, O., Pouliot, F. et al. Achieving the “trifecta” with open versus minimally invasive partial nephrectomy. World J Urol 39, 1569–1575 (2021). https://doi.org/10.1007/s00345-020-03349-y

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  • DOI: https://doi.org/10.1007/s00345-020-03349-y

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