title: Comparison of Trifecta and Pentafecta Outcomes between T1a and T1b Renal Masses following Robot-Assisted Partial Nephrectomy (RAPN) with Minimum One Year Follow Up: Can RAPN for T1b Renal Masses Be Feasible?
abstract: OBJECTIVE
  To investigate the feasibility of RAPN on T1b renal mass by assessment of Trifecta and Pentafecta rate between T1a and T1b renal mass.
  
  
  METHODS
  We retrospectively reviewed the medical records of 277 cases of RPN performed from 2006 to 2015. Sixty patients with clinically T1b renal masses (> 4 cm and ≤ 7 cm) were identified, and from 180 patients with clinically T1a renal mass, 60 patients were matched with T1b renal mass by propensity score. Tumor complexity was investigated according to R.E.N.A.L nephrometry score. "Pentafecta" was defined as achievement of Trifecta (negative surgical margin, no postoperative complications and warm ischemia time of ≤ 25 minutes) with addition of over 90% estimated GFR preservation and no chronic kidney disease stage upgrading at 1 year postoperative period. Propensity score matching was performed by OneToManyMTCH. Logistic regression models were used to identify the variables which predict the Trifecta, and Pentafecta ac.
  
  
  RESULTS
  Preoperative variables (age, sex, body mass index, ASA score) were similar between T1a and T1b after propensity score matching. The median R.E.N.A.L. nephrometry score was 8 vs 9 for T1a and T1b respectively (p<0.001). The median warm ischemia time was 20.1 min vs 26.2 min (p<0.001). Positive surgical margin rate was 5% vs 6.6% (p = 0.729) and overall complication rate of 13.3%. vs 15% (p = 0.793). The rate of achievement of Trifecta rate were 65.3% vs 43.3% (p = 0.017) and Pentafecta rate were 38.3% vs 26.7% (p = 0.172). For achievement of Pentafecta, R.E.N.A.L nephrometry score (HR 0.80; 95% CI (0.67-0.97); p = 0.031) was significant predictor of achieving Pentafecta. Subanalyis to assess the component of R.E.N.A.L nephrometry score, L component (location relative to the polar lines, HR 0.63; 95% CI (0.38-1.03); P = 0.064) was relatively important component for Pentafecta achievement.
  
  
  CONCLUSIONS
  The rate of Pentafecta after RAPN was comparable between T1a and T1b renal masses. RAPN is a feasible modality with excellent long term outcome for patients with larger renal mass (cT1b).
authors.affiliation: Department of Urology, CHA Seoul Station Medical Center, CHA University, CHA Medical School, Seoul, Republic of Korea.|Department of Urology, School of Medicine, Graduate School, Hanyang University, Seoul, Republic of Korea.
authors.forename: Dae Keun
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Department of Urology, Royal Prince Alfred Hospital, Missenden road, Camperdown, Sydney, NSW, Australia.|Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Lawrence H C
authors.initials: LH
authors.lastname: Kim
authors.affiliation: Department of Urology, Tanta University, Tanta, Egypt.|Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Ali Abdel
authors.initials: AA
authors.lastname: Raheem
authors.affiliation: Department of Urology, Chuncheon Sacred Hospital, College of Medicine, Hallym University, Chuncheon, Republic of Korea.
authors.forename: Tae Young
authors.initials: TY
authors.lastname: Shin
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Alabdulaali
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Yoon
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Woong Kyu
authors.initials: WK
authors.lastname: Han
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000145:classification / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D057216:Propensity Score; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome