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J Endourol. 2017 Dec;31(12):1231-1236. doi: 10.1089/end.2017.0369. Epub 2017 Nov 20.

Predictive Factors for Achieving Superior Pentafecta Outcomes Following Robot-Assisted Partial Nephrectomy in Patients with Localized Renal Cell Carcinoma.

Author information

1
1 Department of Urology, Samsung Medical Center, School of Medicine, Sungkyunkwan University , Seoul, Republic of Korea.
2
2 Department of Urology, G SAM Hospital , Gunpo-si, Republic of Korea.
3
3 Kangbuk Samsung Hospital, Seoul, Republic of Korea.

Abstract

PURPOSE:

To examine the perioperative outcomes following robot-assisted partial nephrectomy (RAPN) in patients with localized renal cell carcinoma (RCC) and to identify the predictors of Pentafecta achievement following RAPN.

MATERIALS AND METHODS:

We retrospectively analyzed the data from 362 patients with RCC who underwent RAPN from 2008 to 2016. The criteria for Pentafecta achievement were defined as the Trifecta [warm ischemic time (WIT) ≤25 minutes, negative surgical margin, and no significant perioperative complications]; with the addition of renal function preservation, including over 90% preservation of the estimated glomerular filtration rate (e-GFR); and no stage upgrade of chronic kidney disease at 1 year after surgery. Multivariate logistic regression analysis was performed to determine the predictors of the Pentafecta outcomes.

RESULTS:

Among 362 patients, 82.3% (n = 298) had clinical T1a tumors. The median tumor size was 2.9 cm [interquartile range (IQR) = 2.1-3.6] and median nephrometry score was 7 (IQR = 6-8). The median operative time was 220 minutes (IQR = 185-270) and median estimated blood loss was 150 mL (IQR = 100-200). The median WIT was 20 minutes (IQR = 16-26). The overall rate of postoperative complications was 18.8% (n = 68). The rates of Trifecta and Pentafecta achievement were 66.6% (n = 241/362) and 33.9% (n = 121/303), respectively. Notably, the preoperative e-GFR, hypertension, tumor size, L-component of the R.E.N.A.L score, and surgeon's experience were identified as the significant predictors of Pentafecta achievement. Additionally, patients with T1a tumors showed higher rates of Pentafecta achievement (45.7% vs 25.9%) compared with those of patients with T1b tumors. However, there was no significant difference in the Pentafecta accomplishment rates between the transperitoneal and retroperitoneal approaches.

CONCLUSIONS:

In summary, our data highlighted that tumor size and nephrometry score, which are tumor-related factors, as well as the surgeon's experience, a surgeon-related factor, appear to be the critical predictive factors for Pentafecta achievement following RAPN.

KEYWORDS:

Pentafecta outcome; partial nephrectomy; predictor; renal cell carcinoma; robot-assisted surgery

PMID:
29048228
DOI:
10.1089/end.2017.0369
[Indexed for MEDLINE]

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