title: Robot-Assisted Partial Nephrectomy for T1b Tumors: Strict Trifecta Outcomes.
abstract: OBJECTIVE
  "Trifecta" in partial nephrectomy consists of negative surgical margins, minimal renal function decrease and absence of complications. In the present article, our single-center robot-assisted partial nephrectomy (RAPN) experience in T1b renal masses is reported in terms of strict Trifecta outcomes.
  
  
  METHODS
  This is a retrospective analysis of patients with a tumor diameter between 4 and 7 cm (stage T1b), who underwent RAPN by a single surgeon. Preoperative, intraoperative, and postoperative data were recorded and analyzed to evaluate short-term functional and oncologic outcomes. Patients with absence of grade ≥ 2 Clavien-Dindo complications, warm ischemia time (WIT) ≤25 minutes, ≤15% postoperative estimated glomerular filtration rate (eGFR) decrease and negative surgical margins were reported to achieve strict Trifecta outcomes.P< .05 was indicated statistically significant.
  
  
  RESULTS
  A total of 150 patients underwent RAPN, and 50 patients were identified with tumor size between 4 and 7 cm. Mean WIT was 20.8 ± 6.2 minutes and mean estimated blood loss (EBL) was 269 ± 191 mL. Surgical margins were negative in all patients. Eleven patients (22%) had a >15% eGFR decrease after surgery. Nine patients (18%) had WIT longer than 25 minutes. Four patients (8%) had grade ≥2 Clavien-Dindo complications. Twenty-nine (58%) patients had strict Trifecta outcomes. Mean follow-up was 44.2 ± 27.2 months. Tumor recurrence was not observed in any patient.
  
  
  CONCLUSIONS
  Robot-assisted laparoscopic partial nephrectomy for T1b renal masses can be safely performed in experienced hands. Optimal strict Trifecta outcomes and recurrence rates can be achieved.
authors.affiliation: Department of Urology, School of Medicine, Istanbul Acıbadem University, Istanbul, Turkey.
authors.forename: Ilter
authors.initials: I
authors.lastname: Tufek
authors.affiliation: Department of Urology, School of Medicine, Istanbul Acıbadem University, Istanbul, Turkey.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Mourmouris
authors.affiliation: Department of Urology, Taksim Acıbadem Hospital, Istanbul, Turkey.
authors.forename: Tunkut
authors.initials: T
authors.lastname: Doganca
authors.affiliation: Department of Urology, Taksim Acıbadem Hospital, Istanbul, Turkey.
authors.forename: Can
authors.initials: C
authors.lastname: Obek
authors.affiliation: Department of Urology, School of Medicine, Istanbul Acıbadem University, Istanbul, Turkey.
authors.forename: Omer Burak
authors.initials: OB
authors.lastname: Argun
authors.affiliation: Department of Urology, Acıbadem Maslak Hospital, Istanbul, Turkey.
authors.forename: Mustafa Bilal
authors.initials: MB
authors.lastname: Tuna
authors.affiliation: Department of Urology, School of Medicine, Istanbul Acıbadem University, Istanbul, Turkey.
authors.forename: Mehmet Selcuk
authors.initials: MS
authors.lastname: Keskin
authors.affiliation: Department of Urology, Acıbadem Maslak Hospital, Istanbul, Turkey.
authors.forename: Ali Rıza
authors.initials: AR
authors.lastname: Kural
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome
keywords: Renal mass; Robot-assisted partial nephrectomy; T1b; Trifecta