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

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Abstract

Objective

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.

Methods

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.

Results

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).

Conclusions

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.

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Acknowledgements

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.

Funding

None.

Author information

Authors and Affiliations

  1. Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan

    Junya Furukawa & Masato Fujisawa

  2. Japanese Society of Endourology, Robotic Partial Nephrectomy Observational Study Group, Tokyo, Japan

    Junya Furukawa, 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

  3. Department of Urology, Institute of Biochemical Sciences, Tokushima University, Graduate School, Tokushima, Japan

    Hiroomi Kanayama

  4. Department of Urology, Osaka Medical College, Takatsuki, Japan

    Haruhito Azuma

  5. Department of Urology, Kochi Medical School, Kochi, Japan

    Keiji Inoue

  6. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Yasuyuki Kobayashi

  7. Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan

    Akira Kashiwagi

  8. Department of Urology, Kyoto City Hospital, Kyoto, Japan

    Takehiko Segawa

  9. Department of Urology, Gifu Prefectural General Medical Center, Gifu, Japan

    Yoshihito Takahashi

  10. Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan

    Shigeo Horie

  11. Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Osamu Ogawa

  12. Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan

    Atsushi Takenaka

  13. Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan

    Ryoichi Shiroki

  14. Department of Urology, Tokyo Women’s Medical University, Tokyo, Japan

    Kazunari Tanabe

Authors
  1. Junya Furukawa
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  2. Hiroomi Kanayama
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  3. Haruhito Azuma
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  4. Keiji Inoue
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  5. Yasuyuki Kobayashi
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  6. Akira Kashiwagi
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  7. Takehiko Segawa
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  8. Yoshihito Takahashi
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  9. Shigeo Horie
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  10. Osamu Ogawa
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  11. Atsushi Takenaka
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  12. Ryoichi Shiroki
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  13. Kazunari Tanabe
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  14. Masato Fujisawa
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Corresponding author

Correspondence to Junya Furukawa.

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Furukawa, J., Kanayama, H., Azuma, H. et al. ‘Trifecta’ outcomes of robot-assisted partial nephrectomy: a large Japanese multicenter study. Int J Clin Oncol 25, 347–353 (2020). https://doi.org/10.1007/s10147-019-01565-0

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  • DOI: https://doi.org/10.1007/s10147-019-01565-0

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