title: Achievement of trifecta in minimally invasive partial nephrectomy correlates with functional preservation of operated kidney: a multi-institutional assessment using MAG3 renal scan.
abstract: OBJECTIVE
  To validate and compare the values of "MIC" and "trifecta" as predictors of operated kidney functional preservation in a multi-institutional cohort of patients undergoing minimally invasive PN.
  
  
  METHODS
  We retrospectively reviewed records of consecutive cases of minimally invasive PN performed for cT1 renal masses in 4 centers from 2009 to 2013. Inclusion criteria consisted of availability of a renal scan obtained within 2 weeks prior to surgery and follow-up renal scan 3-6 months after the surgery. The primary endpoint of the study was to compare the degree of ipsilateral renal function preservation assessed by MAG3 renal scan in relation to achievement of MIC and trifecta.
  
  
  RESULTS
  Total of 351 patients met our inclusion criteria. The rates of trifecta achievement for cT1a and cT1b tumors were 78.9 and 60.6 %, respectively. The rate of MIC achievement for cT1a tumors and cT1b tumors was 60.3 and 31.7 %, respectively. On multivariable linear regression model, only the degree of tumor complexity assessed by R.E.N.A.L nephrometry score [coefficient B -1.8 (-2.7, -0.9); p < 0.0001] and the achievement of trifecta [coefficient B 6.1 (2.4,9.8); p = 0.014] or MIC (coefficient B 7.2 (3.8,0.6); p < 0.0001) were significant clinical factors predicting ipsilateral split function preservation.
  
  
  CONCLUSIONS
  Achievement of both MIC and "trifecta" is associated with higher proportion of split renal function preservation for cT1 tumors after minimally invasive PN. Thus, these outcome measures can be regarded not only as markers of surgical quality, but also as reliable surrogates for predicting functional outcome in the operated kidney.
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44016, USA. homi.zargar@gmail.com.
authors.forename: Homayoun
authors.initials: H
authors.lastname: Zargar
authors.affiliation: Division of Urology, Department of Oncology, University of Turin "San Luigi" Hospital, Orbassano, Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.affiliation: Department of Urology, Swedish Medical Center, Seattle, WA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Porter
authors.affiliation: Division of Urology, IRCS National Tumor Institute, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Quarto
authors.affiliation: Division of Urology, IRCS National Tumor Institute, Naples, Italy.
authors.forename: Sisto
authors.initials: S
authors.lastname: Perdona
authors.affiliation: Division of Urology, Department of Oncology, University of Turin "San Luigi" Hospital, Orbassano, Turin, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bertolo
authors.affiliation: Urology Institute, University Hospitals, Cleveland, OH, USA.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44016, USA.
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
mesh_terms: D005260:Female; D006801:Humans; D007668:Kidney / Q000502:physiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009392:Nephrectomy / Q000379:methods*; D063868:Patient Outcome Assessment; D012189:Retrospective Studies
keywords: Functional outcomes; MAG3; Minimally invasive; Partial nephrectomy; Robotic; Trifecta of outcomes