Pre-operative factors that predict trifecta and pentafecta in robotic assisted partial nephrectomy
To prospectively evaluate factors that predict achievement of trifecta and pentafecta following robotic-assisted partial nephrectomy (RAPN). Clinical variables of 330 RAPNs performed for a single renal tumor were analyzed for association with post-operative trifecta and pentafecta achievement. Trife...
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| Veröffentlicht in: | Journal of robotic surgery 2020-02, Vol.14 (1), p.185-190 |
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| creator | Kahn, Amanda E. Shumate, Ashley M. Ball, Colleen T. Thiel, David D. |
| description | To prospectively evaluate factors that predict achievement of trifecta and pentafecta following robotic-assisted partial nephrectomy (RAPN). Clinical variables of 330 RAPNs performed for a single renal tumor were analyzed for association with post-operative trifecta and pentafecta achievement. Trifecta was defined as warm ischemia time (WIT) ≤ 25 min, negative surgical margins, and no post-operative complications ≥ Clavien grade 3. Pentafecta was defined as trifecta criteria plus > 90% preservation of estimated glomerular filtration rate (eGFR) and no stage upgrade of chronic kidney disease from pre-operative up to 12 months post-RAPN. After adjustment for multiple testing,
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| doi_str_mv | 10.1007/s11701-019-00958-7 |
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p
< 0.007 was considered statistically significant. Among 330 patients, trifecta was achieved in 280 patients (84.8%). Among the 152 patients with eGFR available at 12 months following RAPN, pentafecta was achieved in 39 (25.8%). A lower R.E.N.A.L. score was associated with increased odds of achieving trifecta (OR 3.38,
p
< 0.001) and pentafecta (OR 2.83
p
< 0.001). No other pre-operative characteristics were associated with trifecta or pentafecta. Patients who achieved trifecta had a lower median estimated blood loss (EBL) (300 vs 400,
p
= 0.029) and shorter operative time (223 vs 234 min,
p
= 0.004) compared to patients without trifecta. There were no significant differences in EBL or operative time in patients who achieved or failed to achieve pentafecta. R.E.N.A.L score is the only pre-operative variable associated with achieving trifecta and pentafecta following RAPN. Lower EBL and operative time are associated with trifecta but not pentafecta outcomes.</description><identifier>ISSN: 1863-2483</identifier><identifier>EISSN: 1863-2491</identifier><identifier>DOI: 10.1007/s11701-019-00958-7</identifier><identifier>PMID: 30993524</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>Adhesives ; Body mass index ; Calibration ; Cardiovascular disease ; Confidence intervals ; Hemoglobin ; Hypertension ; Ischemia ; Kidney diseases ; Medicine ; Medicine & Public Health ; Minimally Invasive Surgery ; Multivariate analysis ; Original Article ; Patients ; Probability ; Regression analysis ; Robotics ; Surgeons ; Surgery ; Urology ; Variables</subject><ispartof>Journal of robotic surgery, 2020-02, Vol.14 (1), p.185-190</ispartof><rights>Springer-Verlag London Ltd., part of Springer Nature 2019</rights><rights>Springer-Verlag London Ltd., part of Springer Nature 2019.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-89b71c05e770615435d17bcd86970edfd1e01591c0fc1eacb47a06ea42d6f0673</citedby><cites>FETCH-LOGICAL-c375t-89b71c05e770615435d17bcd86970edfd1e01591c0fc1eacb47a06ea42d6f0673</cites><orcidid>0000-0002-5926-3636 ; 0000-0002-8045-4576</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11701-019-00958-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2918716825?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,778,782,21375,21376,27911,27912,33517,33518,33731,33732,41475,42544,43646,43792,51306,64370,64372,64374,72226</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30993524$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kahn, Amanda E.</creatorcontrib><creatorcontrib>Shumate, Ashley M.</creatorcontrib><creatorcontrib>Ball, Colleen T.</creatorcontrib><creatorcontrib>Thiel, David D.</creatorcontrib><title>Pre-operative factors that predict trifecta and pentafecta in robotic assisted partial nephrectomy</title><title>Journal of robotic surgery</title><addtitle>J Robotic Surg</addtitle><addtitle>J Robot Surg</addtitle><description>To prospectively evaluate factors that predict achievement of trifecta and pentafecta following robotic-assisted partial nephrectomy (RAPN). Clinical variables of 330 RAPNs performed for a single renal tumor were analyzed for association with post-operative trifecta and pentafecta achievement. Trifecta was defined as warm ischemia time (WIT) ≤ 25 min, negative surgical margins, and no post-operative complications ≥ Clavien grade 3. Pentafecta was defined as trifecta criteria plus > 90% preservation of estimated glomerular filtration rate (eGFR) and no stage upgrade of chronic kidney disease from pre-operative up to 12 months post-RAPN. After adjustment for multiple testing,
p
< 0.007 was considered statistically significant. Among 330 patients, trifecta was achieved in 280 patients (84.8%). Among the 152 patients with eGFR available at 12 months following RAPN, pentafecta was achieved in 39 (25.8%). A lower R.E.N.A.L. score was associated with increased odds of achieving trifecta (OR 3.38,
p
< 0.001) and pentafecta (OR 2.83
p
< 0.001). No other pre-operative characteristics were associated with trifecta or pentafecta. Patients who achieved trifecta had a lower median estimated blood loss (EBL) (300 vs 400,
p
= 0.029) and shorter operative time (223 vs 234 min,
p
= 0.004) compared to patients without trifecta. There were no significant differences in EBL or operative time in patients who achieved or failed to achieve pentafecta. R.E.N.A.L score is the only pre-operative variable associated with achieving trifecta and pentafecta following RAPN. Lower EBL and operative time are associated with trifecta but not pentafecta outcomes.</description><subject>Adhesives</subject><subject>Body mass index</subject><subject>Calibration</subject><subject>Cardiovascular disease</subject><subject>Confidence intervals</subject><subject>Hemoglobin</subject><subject>Hypertension</subject><subject>Ischemia</subject><subject>Kidney diseases</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minimally Invasive Surgery</subject><subject>Multivariate analysis</subject><subject>Original Article</subject><subject>Patients</subject><subject>Probability</subject><subject>Regression analysis</subject><subject>Robotics</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Urology</subject><subject>Variables</subject><issn>1863-2483</issn><issn>1863-2491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9kU1PHDEMhqOqqHy0f6CHKlIvvQzYk8lkcqwQFCQkOMA5ymQ83aDdyTTJVtp_T2AWKvXAybb8-LXll7GvCKcIoM4SogKsAHUFoGVXqQ_sCLtWVHWj8eNb3olDdpzSI4BUUuAndihAayHr5oj1d5GqMFO02f8lPlqXQ0w8r2zmc6TBu8xz9CO5bLmdBj7TlO1S-onH0IfsHbcp-ZSptG3M3q75RPMqFipsdp_ZwWjXib7s4wl7uLy4P7-qbm5_XZ__vKmcUDJXne4VOpCkFLQoGyEHVL0bulYroGEckAClLsjokKzrG2WhJdvUQztCq8QJ-7HozjH82VLKZuOTo_XaThS2ydQ1gm6xkaKg3_9DH8M2TuU6U2vsFLZdLQtVL5SLIaVIo5mj39i4Mwjm2QGzOGCKA-bFAfN8xbe99Lbf0PA28vryAogFSKU1_ab4b_c7sk8Kx5HF</recordid><startdate>20200201</startdate><enddate>20200201</enddate><creator>Kahn, Amanda E.</creator><creator>Shumate, Ashley M.</creator><creator>Ball, Colleen T.</creator><creator>Thiel, David D.</creator><general>Springer London</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>L6V</scope><scope>M0S</scope><scope>M7S</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5926-3636</orcidid><orcidid>https://orcid.org/0000-0002-8045-4576</orcidid></search><sort><creationdate>20200201</creationdate><title>Pre-operative factors that predict trifecta and pentafecta in robotic assisted partial nephrectomy</title><author>Kahn, Amanda E. ; Shumate, Ashley M. ; Ball, Colleen T. ; Thiel, David D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-89b71c05e770615435d17bcd86970edfd1e01591c0fc1eacb47a06ea42d6f0673</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adhesives</topic><topic>Body mass index</topic><topic>Calibration</topic><topic>Cardiovascular disease</topic><topic>Confidence intervals</topic><topic>Hemoglobin</topic><topic>Hypertension</topic><topic>Ischemia</topic><topic>Kidney diseases</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Minimally Invasive Surgery</topic><topic>Multivariate analysis</topic><topic>Original Article</topic><topic>Patients</topic><topic>Probability</topic><topic>Regression analysis</topic><topic>Robotics</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Urology</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kahn, Amanda E.</creatorcontrib><creatorcontrib>Shumate, Ashley M.</creatorcontrib><creatorcontrib>Ball, Colleen T.</creatorcontrib><creatorcontrib>Thiel, David D.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>Technology Collection (ProQuest)</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Engineering Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Engineering Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Engineering Collection</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of robotic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kahn, Amanda E.</au><au>Shumate, Ashley M.</au><au>Ball, Colleen T.</au><au>Thiel, David D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pre-operative factors that predict trifecta and pentafecta in robotic assisted partial nephrectomy</atitle><jtitle>Journal of robotic surgery</jtitle><stitle>J Robotic Surg</stitle><addtitle>J Robot Surg</addtitle><date>2020-02-01</date><risdate>2020</risdate><volume>14</volume><issue>1</issue><spage>185</spage><epage>190</epage><pages>185-190</pages><issn>1863-2483</issn><eissn>1863-2491</eissn><abstract>To prospectively evaluate factors that predict achievement of trifecta and pentafecta following robotic-assisted partial nephrectomy (RAPN). Clinical variables of 330 RAPNs performed for a single renal tumor were analyzed for association with post-operative trifecta and pentafecta achievement. Trifecta was defined as warm ischemia time (WIT) ≤ 25 min, negative surgical margins, and no post-operative complications ≥ Clavien grade 3. Pentafecta was defined as trifecta criteria plus > 90% preservation of estimated glomerular filtration rate (eGFR) and no stage upgrade of chronic kidney disease from pre-operative up to 12 months post-RAPN. After adjustment for multiple testing,
p
< 0.007 was considered statistically significant. Among 330 patients, trifecta was achieved in 280 patients (84.8%). Among the 152 patients with eGFR available at 12 months following RAPN, pentafecta was achieved in 39 (25.8%). A lower R.E.N.A.L. score was associated with increased odds of achieving trifecta (OR 3.38,
p
< 0.001) and pentafecta (OR 2.83
p
< 0.001). No other pre-operative characteristics were associated with trifecta or pentafecta. Patients who achieved trifecta had a lower median estimated blood loss (EBL) (300 vs 400,
p
= 0.029) and shorter operative time (223 vs 234 min,
p
= 0.004) compared to patients without trifecta. There were no significant differences in EBL or operative time in patients who achieved or failed to achieve pentafecta. R.E.N.A.L score is the only pre-operative variable associated with achieving trifecta and pentafecta following RAPN. Lower EBL and operative time are associated with trifecta but not pentafecta outcomes.</abstract><cop>London</cop><pub>Springer London</pub><pmid>30993524</pmid><doi>10.1007/s11701-019-00958-7</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-5926-3636</orcidid><orcidid>https://orcid.org/0000-0002-8045-4576</orcidid></addata></record> |
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| subjects | Adhesives Body mass index Calibration Cardiovascular disease Confidence intervals Hemoglobin Hypertension Ischemia Kidney diseases Medicine Medicine & Public Health Minimally Invasive Surgery Multivariate analysis Original Article Patients Probability Regression analysis Robotics Surgeons Surgery Urology Variables |
| title | Pre-operative factors that predict trifecta and pentafecta in robotic assisted partial nephrectomy |
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