‘Trifecta’ outcomes of robot-assisted partial nephrectomy: a large Japanese multicenter study

  • Junya FurukawaEmail author
  • Hiroomi Kanayama
  • Haruhito Azuma
  • Keiji Inoue
  • Yasuyuki Kobayashi
  • Akira Kashiwagi
  • Takehiko Segawa
  • Yoshihito Takahashi
  • Shigeo Horie
  • Osamu Ogawa
  • Atsushi Takenaka
  • Ryoichi Shiroki
  • Kazunari Tanabe
  • Masato Fujisawa
Original Article



The objective of this study was to evaluate the early surgical outcomes of robot-assisted partial nephrectomy (RAPN) for small renal masses in a large Japanese multicenter series.


A total of 804 consecutive cases of RAPN were examined at 42 institutes between 2011 and 2016. Medical records for clinical, pathological characteristics and perioperative outcomes were retrospectively reviewed. Univariable and multivariable analyses were performed to determine factors predicting Trifecta achievement.


The median tumor size was 2.6 cm. The median RENAL score was 7. The median warm ischemia time was 21 min. The median estimated blood loss was 30 mL. Eight patients (1.0%) were converted to radical nephrectomy. The overall and Clavien–Dindo grade ≥ 3 complication rates were 13.0% and 5.8%, respectively. Pathologically, 91.4% of tumors were malignant and the positive surgical margin (PSM) rate was 1.1%. During the median 27.1-month observation period, the recurrence rate was 1.6%. Postoperative preservation rates of eGFR at 1, 6, 12 and 24 months were 90.3, 89.8, 89.4 and 89.2%, respectively. Trifecta was achieved in 62.1%. Multivariable analysis demonstrated that tumor diameter, estimated blood loss and hilar location of the tumor were significant negative factors predicting Trifecta achievement. The rate of Trifecta achievement for T1b tumors and hilar tumors was significantly lower (48.4% and 50.0%, respectively).


RAPN was safely performed with acceptable oncological and functional outcomes, but the rate of Trifecta accomplishment for T1b or hilar tumors was significantly lower than that for T1a or non-hilar tumors, respectively.


Robot-assisted partial nephrectomy Trifecta Perioperative outcomes Nephron-sparing surgery 



The authors thank Dr. Omori, Division of Biostatics, Department of Social/Community Medicine and Health Science, Kobe University School of Medicine for their advice and expertise with the statistical analysis. The authors thank the members of the Clinical and Translational Research Center, Kobe University Hospital for their helpful assistance.



Compliance with ethical standards

Conflict of interest

The authors have explicitly stated that there are no conflicts in connection with this article.

Supplementary material

10147_2019_1565_MOESM1_ESM.pptx (40 kb)
Supplementary file1 (PPTX 40 kb)


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Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  • Junya Furukawa
    • 1
    • 2
    Email author
  • Hiroomi Kanayama
    • 2
    • 3
  • Haruhito Azuma
    • 2
    • 4
  • Keiji Inoue
    • 2
    • 5
  • Yasuyuki Kobayashi
    • 2
    • 6
  • Akira Kashiwagi
    • 2
    • 7
  • Takehiko Segawa
    • 2
    • 8
  • Yoshihito Takahashi
    • 2
    • 9
  • Shigeo Horie
    • 2
    • 10
  • Osamu Ogawa
    • 2
    • 11
  • Atsushi Takenaka
    • 2
    • 12
  • Ryoichi Shiroki
    • 2
    • 13
  • Kazunari Tanabe
    • 2
    • 14
  • Masato Fujisawa
    • 1
    • 2
  1. 1.Division of UrologyKobe University Graduate School of MedicineKobeJapan
  2. 2.Japanese Society of Endourology, Robotic Partial Nephrectomy Observational Study GroupTokyoJapan
  3. 3.Department of Urology, Institute of Biochemical SciencesTokushima University, Graduate SchoolTokushimaJapan
  4. 4.Department of UrologyOsaka Medical CollegeTakatsukiJapan
  5. 5.Department of UrologyKochi Medical SchoolKochiJapan
  6. 6.Department of UrologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
  7. 7.Department of UrologyTeine Keijinkai HospitalSapporoJapan
  8. 8.Department of UrologyKyoto City HospitalKyotoJapan
  9. 9.Department of UrologyGifu Prefectural General Medical CenterGifuJapan
  10. 10.Department of UrologyJuntendo University Graduate School of MedicineTokyoJapan
  11. 11.Department of UrologyKyoto University Graduate School of MedicineKyotoJapan
  12. 12.Division of Urology, Department of SurgeryTottori University Faculty of MedicineYonagoJapan
  13. 13.Department of UrologyFujita Health University School of MedicineToyoakeJapan
  14. 14.Department of UrologyTokyo Women’s Medical UniversityTokyoJapan

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