Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA.
J Robot Surg. 2020 Feb;14(1):185-190. doi: 10.1007/s11701-019-00958-7. Epub 2019 Apr 16.
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.
前瞻性评估预测机器人辅助部分肾切除术 (RAPN) 后 trifecta 和 pentafecta 实现的因素。分析了 330 例单一肾肿瘤行 RAPN 的临床变量，以评估与术后 trifecta 和 pentafecta 实现的相关性。 trifecta 定义为热缺血时间 (WIT) ≤ 25 分钟，无手术切缘阳性，无术后并发症 ≥ Clavien 3 级。pentafecta 的定义为 trifecta 标准加上估计肾小球滤过率 (eGFR) 的保存率 > 90%，且 RAPN 术前至术后 12 个月慢性肾脏病分期无升级。在多重检验校正后，p < 0.007 被认为具有统计学意义。在 330 例患者中，280 例（84.8%）实现了 trifecta。在 152 例 RAPN 后 12 个月可获得 eGFR 的患者中，39 例（25.8%）实现了 pentafecta。较低的 R.E.N.A.L. 评分与 trifecta （OR 3.38，p < 0.001）和 pentafecta （OR 2.83，p < 0.001）实现的可能性增加相关。术前其他特征与 trifecta 或 pentafecta 无关。与未达到 trifecta 的患者相比，达到 trifecta 的患者的中位估计失血量 (EBL)（300 比 400，p = 0.029）和手术时间（223 比 234 分钟，p = 0.004）更短。在达到 pentafecta 或未达到 pentafecta 的患者中，EBL 或手术时间无显著差异。R.E.N.A.L. 评分是唯一与 RAPN 后达到 trifecta 和 pentafecta 相关的术前变量。较低的 EBL 和手术时间与 trifecta 相关，但与 pentafecta 结果无关。
