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R-LESS Partial Nephrectomy Trifecta Outcome Is Inferior to Multiport Robotic Partial Nephrectomy: Comparative Analysis

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Author(s)
Christos KomninosTae Young ShinPatrick TuliaoYoung Eun YoonKyo Chul KooChien-Hsiang ChangSang Woon KimJi Yong HaWoong Kyu HanKoon Ho Rha
Keimyung Author(s)
Ha, Ji Yong
Department
Dept. of Urology (비뇨의학)
Journal Title
European Urology
Issued Date
2014
Volume
66
Issue
3
Abstract
Background: Trifecta achievement in partial nephrectomy (PN) is defined as the combination
of warm ischemia time 20 min, negative surgical margins, and no surgical
complications.
Objective: To compare trifecta achievement between robotic, laparoendoscopic, singlesite
(R-LESS) PN and multiport robotic PN (RPN).
Design, setting, and participants: Data from 167 patients who underwent RPN from
2006 to 2012 were retrospectively analyzed.
Outcome measurements and statistical analysis: Primary outcome measurement was
trifecta achievement; secondary outcome was the perioperative and postoperative
comparison between groups. The measurements were estimated and analyzed with
SPSS v.18 using univariable, multivariable, and subgroup analyses.
Results and limitations: Eighty-nine patients were treated with RPN and 78 were
treated with R-LESS PN. Baseline characteristics of both groups were similar. Trifecta
was achieved in 38 patients (42.7%) in the multiport RPN group and 20 patients (25.6%)
in the R-LESS PN group ( p = 0.021). Patients in the R-LESS PN group had longer mean
operative time, warm ischemia time, and increased estimated glomerular filtration rate
(eGFR) percentage change. No significant differences were found between the two
groups in days of hospitalization, blood loss, postoperative eGFR, positive surgical
margins, and surgical complications. Patients with increased PADUA and RENAL scores,
infiltration of the collecting system, and renal sinus involvement had an increased
probability of not achieving the trifecta. In regression analysis, the type of procedure
and the tumor size could predict trifecta accomplishment ( p = 0.019 and 0.043,
respectively). The retrospective study, the low number of series, and the controversial
definition of trifecta were the main limitations.
Conclusions: The trifecta was achieved in significantly more patients who underwent
multiport RPN than those who underwent R-LESS PN. R-LESS PN could be an alternative
option for patients with decreased tumor size, low PADUA and RENAL scores, and
without renal sinus or collecting system involvement.
Patient summary: In this study, we looked at the outcomes of patients who had
undergone robotic partial nephrectomy. We found that conventional robotic partial
nephrectomy is superior to R-LESS partial nephrectomy with regard to the accomplishment
of negative margins, reduced warm ischemia time, and minimal surgical
complications.
Keimyung Author(s)(Kor)
하지용
Publisher
School of Medicine
Citation
Christos Komninos et al. (2014). R-LESS Partial Nephrectomy Trifecta Outcome Is Inferior to
Multiport Robotic Partial Nephrectomy: Comparative Analysis. European Urology, 66(3), 512–517. doi: 10.1016/j.eururo.2013.10.058
Type
Article
ISSN
0302-2838
Source
http://lps3.www.sciencedirect.com.proxy.dsmc.or.kr/science/article/pii/S0302283813011962?via%3Dihub
DOI
10.1016/j.eururo.2013.10.058
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/35694
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Urology (비뇨의학)
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