Pre-operative factors that predict trifecta and pentafecta in robotic assisted partial nephrectomy

Abstract

To prospectively evaluate factors that predict achievement of trifecta and pentafecta following robotic-assisted partial nephrectomy (RAPN). Clinical variables of 330 RAPNs performed for a single renal tumor were analyzed for association with post-operative trifecta and pentafecta achievement. Trifecta was defined as warm ischemia time (WIT) ≤ 25 min, negative surgical margins, and no post-operative complications ≥ Clavien grade 3. Pentafecta was defined as trifecta criteria plus > 90% preservation of estimated glomerular filtration rate (eGFR) and no stage upgrade of chronic kidney disease from pre-operative up to 12 months post-RAPN. After adjustment for multiple testing, p < 0.007 was considered statistically significant. Among 330 patients, trifecta was achieved in 280 patients (84.8%). Among the 152 patients with eGFR available at 12 months following RAPN, pentafecta was achieved in 39 (25.8%). A lower R.E.N.A.L. score was associated with increased odds of achieving trifecta (OR 3.38, p < 0.001) and pentafecta (OR 2.83 p < 0.001). No other pre-operative characteristics were associated with trifecta or pentafecta. Patients who achieved trifecta had a lower median estimated blood loss (EBL) (300 vs 400, p = 0.029) and shorter operative time (223 vs 234 min, p = 0.004) compared to patients without trifecta. There were no significant differences in EBL or operative time in patients who achieved or failed to achieve pentafecta. R.E.N.A.L score is the only pre-operative variable associated with achieving trifecta and pentafecta following RAPN. Lower EBL and operative time are associated with trifecta but not pentafecta outcomes.