1. Achieving the 'trifecta' with open versus minimally invasive partial nephrectomy
- Author
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Luke T. Lavallée, Samrad Ghavimi, Ronald B. Moore, Frédéric Pouliot, Zhihui Liu, Adrian Fairey, Olli Saarela, Michael A.S. Jewett, Simon Tanguay, Peter C. Black, Rodney H. Breau, Ricardo A. Rendon, Louis Lacombe, Anil Kapoor, and Antonio Finelli
- Subjects
Nephrology ,Male ,medicine.medical_specialty ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Renal function ,Nephrectomy ,Continuous variable ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,stomatognathic system ,Robotic Surgical Procedures ,Internal medicine ,medicine ,Independence test ,Humans ,In patient ,Prospective Studies ,Aged ,business.industry ,Confounding ,Margins of Excision ,Middle Aged ,medicine.disease ,Kidney Neoplasms ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Laparoscopy ,business ,Kidney cancer ,Glomerular Filtration Rate - Abstract
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). 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. 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. 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.
- Published
- 2020