EAU 2019: A Novel Trifecta to Simplify the Assessment of Perioperative Outcomes After Robot Assisted Partial Nephrectomy for cT1 Renal Masses: Results of a Multicenter Series

Barcelona, Spain (UroToday.com) There are two distinct definitions of trifecta outcomes after partial nephrectomy; one requiring a volumetric assessment of the percentage of parenchyma spared, the other requiring a conventional on-clamp approach to be used. Recently, the US FDA and the National Kidney Foundation recommended considering a 30% decrease of eGFR as a clinically relevant acute kidney injury with potential implication on long term development of chronic kidney disease.

Authors integrated 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.

Dr. Anceschi and colleagues analyzed baseline and perioperative outcomes of 1336 pooled patients who underwent robotic-assisted partial nephrectomy (RAPN) for cT1 renal masses in 5 different tertiary referral centers. Univariable and multivariable logistic regression analyses were performed to identify predictors of trifecta outcomes.

Dr. Anceschi and colleagues presented that the positive surgical margin rate was 3.7%. Only 1.1% of patients experienced a Clavien III-V complications, 27.6% had an ∆eGFR of >30%. Overall, trifecta outcomes were achieved in 906 patients (67.8%). 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 probability of achieving trifecta.

Based on their results, the authors developed a novel trifecta, combining negative margins, no severe perioperative complications and perioperative 30% decrease of eGFR into a single comprehensive outcome assessment.

Presented by: Umberto Anceschi, Consultant Urologist presso IFO, Regina Elena National Cancer Institute, Department of Urology, Rome, Italy 

Written by: Olesya Snurnitsyna, MD, Fellow, Department of Urology, Sechenov University, Moscow, Russia at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.