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Background: To explore predictors of positive surgical margins (PSM) after robotic partial nephrectomy (PN) in a large multicenter international observational project, harnessing the Surface-Intermediate-Base (SIB) margin score to report the resection technique after PN in a standardized way. Methods: Data from consecutive patients with cT1-2N0M0 renal masses treated with PN from September 2014 to March 2015 at 16 tertiary referral centers and included in the SIB margin score International Consortium were prospectively collected. For the present study, only patients treated with robotic PN were included. Uni- and multivariable analysis were fitted to explore clinical and surgical predictors of PSMs after PN. Results: Overall, 289 patients were enrolled. Median (IQR) preoperative tumor size was 3.0 (2.3–4.2) cm and median (IQR) PADUA score was 8 (7–9). SIB scores of 0–2 (enucleation), 3–4 (enucleoresection) and 5 (resection) were reported in 53.3%, 27.3% and 19.4% of cases, respectively. A PSM was recorded in 18 (6.2%) patients. PSM rate was 4.5%, 11.4% and 3.6% in case of enucleation, enucleoresection and resection, respectively. Patients with PSMs had tumors with a higher rate of contact with the urinary collecting system (55.6% vs. 27.3%; p < 0.001) and a longer median warm ischemia time (22 vs. 16 min; p = 0.02) compared with patients with negative surgical margins, while no differences emerged between the two groups in terms of other tumor features (i.e., pathological diameter, PADUA score). In multivariable analysis, only enucleoresection (SIB score 3–4) versus enucleation (SIB score 0–2) was found to be an independent predictor of PSM at final pathology (HR: 2.68; 95% CI: 1.25–7.63; p = 0.04), while resection (SIB score 5) was not. Conclusions: In our experience, enucleoresection led to a higher risk of PSMs as compared to enucleation. Further studies are needed to assess the differential impacts of resection technique and surgeon's experience on margin status after robotic PN. [ABSTRACT FROM AUTHOR]

We aimed to compare the outcomes of open vs robotic partial nephrectomy (PN), focusing on predictors of Trifecta failure in patients with highly complex renal masses. We queried the prospectively collected database from the SIB International Consortium, including 507 consecutive patients with cT1-2N0M0 renal masses treated at 16 high-volume referral centres, to select those with highly complex (PADUA score ≥10) tumors undergoing PN. RT was classified as enucleation, enucleoresection or resection according to the SIB score. Trifecta was defined as achievement of negative surgical margins, no acute kidney injury and no Clavien-Dindo grade ≥2 postoperative surgical complications. Multivariable logistic regression analysis was used to assess independent predictors of Trifecta failure. 113 patients were included. Patients undergoing open PN (n = 47, 41.6%) and robotic PN (n = 66, 58.4%) were comparable in baseline characteristics. RT was classified as enucleation, enucleoresection and resection in 46.9%, 34.0% and 19.1% of open PN, and in 50.0%, 40.9% and 9.1% of robotic PN (p = 0.28). Trifecta was achieved in significantly more patients after robotic PN (69.7% vs. 42.6%, p = 0.004). On multivariable analysis, surgical approach (open vs robotic, OR: 2.62; 95%CI: 1.11–6.15, p = 0.027) and tumor complexity (OR for each additional unit of the PADUA score: 2.27; 95%CI: 1.27–4.06, p = 0.006) were significant predictors of Trifecta failure, while RT was not. The study is limited by lack of randomization; as such, selection bias and confounding cannot be entirely ruled out. Tumor complexity and surgical approach were independent predictors of Trifecta failure after PN for highly complex renal masses. [ABSTRACT FROM AUTHOR]

Introduction: The present study aimed to compare the assessment of volume preservation and perioperative outcomes during partial nephrectomy (PN), according to the surface-intermediate-base (SIB) score. Methods: This prospective study included 80 patients diagnosed with renal cell carcinoma who underwent PN for a renal mass from 2014 to 2017. SIB score was macroscopically evaluated immediately after the surgery. Preoperative assessment of volume preservation (PAVP), surgeon assessment of volume preservation (SAVP), duration of ischemia, perioperative complications, pathological data, and the values of preoperative and postoperative estimated glomerular filtration rate (eGFR) were recorded. Results: A strong correlation was determined between PAVP and SAVP (R = 0.82, R2 = 0.68, p < 0.0001) and between vGFR-PAVP and vGFR-SAVP calculated using the adapted eGFR (preop eGFR × [PAVP or SAVP]) (R = 0.97, R2 = 0.95, p < 0.001). In multivariate analysis, preoperative tumor size, SIB score (1–2 vs. 3–5), and vGFR (PAVP and SAVP model) were significant predictors of postoperative eGFR. A low base score was associated with surgical margin positivity, and a high SIB score (≥3) was associated with perioperative complications (p = 0.017; p = 0.028). Conclusion: The SIB score can be considered a reliable surrogate for volume preservation after PN because it is strongly associated with both PAVP and SAVP. SIB score is useful in predicting functional outcomes, complications, and surgical margin positivity. [ABSTRACT FROM AUTHOR]