TORNA ALL’ELENCO

A novel trifecta to simplify the assessment of perioperative outcomes after robot assisted partial nephrectomy for cT1 renal masses: Results of a multicenter series in European Urology, Supplements

2019
AOU San Luigi di Orbassano

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (23)Vedi tutti...

Anceschi U
University of Messina, Messina, Italy
Bertolo R
University of Messina, Messina, Italy
Brassetti A
University of Messina, Messina, Italy

et alii...

Abstract

Introduction & Objectives: Two different definitions of trifecta outcomes after partial nephrectomy are available in Literature, one requiring a volumetric assessment of percentage of parenchyma spared [1], the other requiring a conventional on-clamp approach to be used [2]. Recently, the US FDA and the National Kidney Foundation recommended to consider a 30% decrease of eGFR as a clinically relevant acute kidney injury with potential implication on long term development of chronic kidney disease [3]. The aim of this study is to integrate this data into trifecta system for an easy and wide clinical use in patients treated with RAPN for cT1 renal tumor and to assess factors predicting its achievement. Materials & Methods: From September 2006 to October 2018, we analyzed baseline and perioperative outcomes of 1336 pooled patients who underwent RAPN for cT1 renal masses in 11 different tertiary referral centers. Trifecta were defined as “negative margins”; no major complications (Clavien 3-5); ?eGFR mL/min/1.73 m2 {([baseline eGFR- eGFR at discharge]/baseline eGFR)*100} <30%. Univariable and multivariable logistic regression analyses were performed to identify predictors of trifecta outcomes. For all statistical analyses, a two-sided p<0.05 was considered significant. Results: No patient had conversion to open surgery or radical nephrectomy. The positive surgical margins rate was 3.7%; 1.1% of patients experienced a Clavien III-V complications, 27.6% had a ?eGFR >30%. Overall, trifecta outcomes were achieved in 906 patients (67.8%). On univariable analysis, continuously coded warm ischemia time (p=0.005), female gender (p=0.03), tumor size (p=0.001), hypertension (p=0.02)and RENAL score (p=0.001)were associated with an increased risk of not achieving trifecta (Table 1). On multivariable analysis, warm ischemia time was the only independent predictor of achieving trifecta (p=0.001); any increasing minute of warm ischemia time was associated with 6% reduced

DOI : 10.1016/S1569-9056(19)30325-2

Keywords

robotics; radical nephrectomy; probability; peroperative complication; partial nephrectomy; multicenter study; male; kidney tumor; major clinical study; ischemia; human; hypertension; female; gender; estimated glomerular filtration rate; conversion to open surgery; controlled study; conference abstract; complication; surgical margin; clinical assessment; chronic kidney failure; cancer size; adult; acute kidney failure; achievement; tertiary care center;