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ORIGINAL ARTICLE
Minerva Urologica e Nefrologica 2020 June;72(3):339-49
DOI: 10.23736/S0393-2249.19.03485-4
Copyright © 2019 EDIZIONI MINERVA MEDICA
lingua: Inglese
Which patients with clinical localized renal mass would achieve the trifecta after partial nephrectomy? The impact of surgical technique
Lorenzo BIANCHI 1, 2 ✉, Riccardo SCHIAVINA 1, 2, Marco BORGHESI 1, 2, Francesco CHESSA 1, 2, Carlo CASABLANCA 1, Andrea ANGIOLINI 1, Amelio ERCOLINO 1, Cristian V. PULTRONE 1, 2, Federico MINEO BIANCHI 1, Umberto BARBARESI 1, Pietro PIAZZA 1, Fabio MANFERRARI 1, 2, Alessandro BERTACCINI 1, 2, Michelangelo FIORENTINO 3, Matteo FERRO 4, Angelo PORRECA 5, Emanuela MARCELLI 2, 3, 4, 5, 6, Eugenio BRUNOCILLA 1, 2
1 Department of Urology, Sant’Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy; 2 Department of Specialistic, Diagnostic and Sperimental Medicine (DIMES), University of Bologna, Bologna, Italy; 3 Laboratory of Oncologic Molecular Pathology, Sant’Orsola-Malpighi Teaching Hospital, University of Bologna, Bologna, Italy; 4 Istituto Europeo di Urologia, Milan, Italy; 5 Department of Urology, Abano Terme Hospital, Padua, Italy; 6 Laboratory of Bioengineering, Department of Experimental Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
BACKGROUND: To develop a clinical nomogram aimed to predict the achievement of trifecta in patients treated with open, laparoscopic and robotic partial nephrectomy (PN) for localized renal masses (
RESULTS: The three cohorts were comparable in terms of demographics and clinical characteristics. Trifecta has been achieved in 49%, 50.6% and 69.9% of patients undergoing OPN, LPN and RAPN, respectively (P=0.003). At multivariable analyses, American Anesthesiologists Score (ASA) score 3-4 (Odd Ratio [OR]: 0.63; P=0.02), urinary collecting system (UCS) involvement (OR 0.56; P=0.02) and surgical approach (LPN and OPN vs. RAPN: OR: 0.39 and 0.38, respectively; P=0.001) were independent predictors of trifecta’s achievement. A nomogram based on covariates included in the multivariable model demonstrated bootstrap-corrected predictive accuracy of 63%.
CONCLUSIONS: ASA Score, UCS involvement and the surgical technique were independent predictors of trifecta outcome. Our nomogram could facilitate the preoperative counselling and to choose the best surgical approach for PN.
KEY WORDS: Kidney neoplasms; Nephrectomy; Nomograms