Preoperative factors affecting a rate of trifecta and pentafecta achievement after partial nephrectomy

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Introduction. Trifecta and pentafecta parameters have been described in modern literature to better define success following partial nephrectomy (PN). In this study an association between patient- and tumor-specific variables with achievement of trifecta and pentafecta was examined in order to better predict outcomes following PN.

Aim. To define preoperative parameters that predict achievement of trifecta and pentafecta following PN.

Materials and methods. A total of 1218 open PN were performed by a single experienced surgeon between Jan 2010 and Dec 2019 for localized renal cell cancer in S.P. Botkin Moscow City Clinical Hospital. From prospective database we retrospectively analyzed the patient-related (age, sex, body mass index, hypertension, cardiovascular disease, hemoglobin, estimated glomerular filtration rate [eGFR], preoperative chronic kidney disease stage) and tumor-related (R.E.N.A.L score, renal mass size and intraparenchymal tumor location index) as potential predictive factors.

Results. The outcomes of PN performed in 1114 patients were analyzed. Trifecta was achieved in 705 cases (78.0%). Among the 632 patients with eGFR available at 12 months following robot-assisted PN, pentafecta was achieved in 180 cases (28.5%). Tumor size less then 4 cm (OR= 3.17, 95% СI 1.73–5.84, p<0,001), extraparenchymal tumor location (OR= 2.78, 95% CI 1.54–5.44, p<0,001) and lower R.E.N.A.L. score (6 vs 9) were all associated with increased odds of achieving trifecta (OR 3.37, CI=1,94–6,27, p < 0.001). Preoperative eGFR less then 60 ml/min was associated with pentafecta achievement (OR=2.73, 95% CI 1.62–5.21, p<0,001) as well as above mentioned variables associated with trifecta.

Conclusion: Preoperative R.E.N.A.L score was the only variable associated with achieving trifecta and pentafecta following robot-assisted PN, while kidney function indicators was associated with pentafecta achievement.

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作者简介

А. Seregin

S.P. Botkin city clinical hospital; Russian Medical Academy of Continuous Professional Education

编辑信件的主要联系方式.
Email: sasha.seregin@gmail.com
ORCID iD: 0000-0002-6627-2266
Scopus 作者 ID: 198395

Ph.D., urologist at the Department of Urology, associate professor at the Department of Urology and Surgical Andrology 

俄罗斯联邦, Moscow; Moscow

А. Seregin

S.P. Botkin city clinical hospital; Russian Medical Academy of Continuous Professional Education

Email: av_seregin@mail.ru

Ph.D., Head of the Department of Urology, professor at the Department of Urology and Surgical Andrology

俄罗斯联邦, Moscow; Moscow

K. Kolontarev

A.I. Evdokimov Moscow State University of Medicine and Dentistry

Email: kb80@yandex.ru
ORCID iD: 0000-0003-4511-5998

Ph.D., MD, Head of the Department of Oncourology, professor at the Department of Urology 

俄罗斯联邦, Moscow

N. Shustitskiy

S.P. Botkin city clinical hospital; Russian Medical Academy of Continuous Professional Education

Email: shustnick@yandex.ru

Ph.D., urologist at the Department of Urology 

俄罗斯联邦, Moscow; Moscow

I. Chekhonatskiy

Russian Medical Academy of Continuous Professional Education

Email: ilya.est@yandex.ru

senior laboratory assistant at the Department of Urology and Surgical Andrology

俄罗斯联邦, Moscow

О. Loran

S.P. Botkin city clinical hospital; Russian Medical Academy of Continuous Professional Education

Email: oleg_loran@gmail.com

Academician of RAS, Ph.D., MD, professor, Chief of the Department of Urology, Head of the Department of Urology and Surgical Andrology, Honored Scientist of Russian Federation, Honored Doctor of the Russian Federation 

俄罗斯联邦, Moscow; Moscow

参考

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2. Fig. 1. Frequency of achieving the “trifecta” depending on the number of points on the R.E.N.A.L. scale.

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3. Fig. 2. The frequency of achieving “pentafecta” depending on the number of points on the R.E.N.A.L. scale.

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