Predictive Factors for Achieving Superior Pentafecta Outcomes Following Robot-Assisted Partial Nephrectomy in Patients with Localized Renal Cell Carcinoma.

Abstract

To examine the perioperative outcomes following robot-assisted partial nephrectomy (RAPN) in patients with localized renal cell carcinoma (RCC) and to identify the predictors of Pentafecta achievement following RAPN. We retrospectively analyzed the data from 362 patients with RCC who underwent RAPN from 2008 to 2016. The criteria for Pentafecta achievement were defined as the Trifecta [warm ischemic time (WIT) ≤25 minutes, negative surgical margin, and no significant perioperative complications]; with the addition of renal function preservation, including over 90% preservation of the estimated glomerular filtration rate (e-GFR); and no stage upgrade of chronic kidney disease at 1 year after surgery. Multivariate logistic regression analysis was performed to determine the predictors of the Pentafecta outcomes. Among 362 patients, 82.3% (n = 298) had clinical T1a tumors. The median tumor size was 2.9 cm [interquartile range (IQR) = 2.1-3.6] and median nephrometry score was 7 (IQR = 6-8). The median operative time was 220 minutes (IQR = 185-270) and median estimated blood loss was 150 mL (IQR = 100-200). The median WIT was 20 minutes (IQR = 16-26). The overall rate of postoperative complications was 18.8% (n = 68). The rates of Trifecta and Pentafecta achievement were 66.6% (n = 241/362) and 33.9% (n = 121/303), respectively. Notably, the preoperative e-GFR, hypertension, tumor size, L-component of the R.E.N.A.L score, and surgeon's experience were identified as the significant predictors of Pentafecta achievement. Additionally, patients with T1a tumors showed higher rates of Pentafecta achievement (45.7% vs 25.9%) compared with those of patients with T1b tumors. However, there was no significant difference in the Pentafecta accomplishment rates between the transperitoneal and retroperitoneal approaches. In summary, our data highlighted that tumor size and nephrometry score, which are tumor-related factors, as well as the surgeon's experience, a surgeon-related factor, appear to be the critical predictive factors for Pentafecta achievement following RAPN.