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Factors affecting renal function preservation among patients not achieving trifecta after laparoscopic partial nephrectomy for clinical T1a renal masses
Author(s) -
Takeda Toshikazu,
Komatsuda Akari,
Yanai Yoshinori,
Tanaka Nobuyuki,
Matsumoto Kazuhiro,
Morita Shinya,
Kosaka Takeo,
Mizuno Ryuichi,
Shinojima Toshiaki,
Asanuma Hiroshi,
Oya Mototsugu
Publication year - 2020
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/ases.12776
Subject(s) - nephrectomy , medicine , renal function , univariate analysis , urology , surgery , kidney , multivariate analysis
The goal of partial nephrectomy for renal tumors is complete tumor removal with the preservation of renal function and no complications. Trifecta (total ischemia time < 25 minutes, negative surgical margins, and no surgical complications) is widely used to evaluate success after partial nephrectomy. We investigated factors affecting renal function preservation among patients not achieving trifecta after laparoscopic partial nephrectomy. Methods Sixty‐six patients who underwent laparoscopic partial nephrectomy for clinical T1a renal masses between December 2006 and March 2016 were examined. We defined preserved renal function as the preservation of an estimated glomerular filtration rate ≥ 90% 1 year after surgery. We examined factors affecting renal function preservation among patients not achieving trifecta after laparoscopic partial nephrectomy. Results Thirty out of 66 patients (45%) did not achieve trifecta. In an evaluation of 66 patients, a multivariate analysis identified tumor size ( P = .04) as an independent predictor affecting the achievement of trifecta. Tumor size was significantly smaller in the trifecta achievement group (1.9 ± 0.1 cm) than in the non‐achievement group (2.2 ± 0.6 cm) ( P = .04). We found that renal function was preserved 1 year after surgery in 14 out of the 30 patients not achieving trifecta. In univariate analysis, age ( P = .01) was significantly associated with affecting the preservation of renal function among these patients. Patients with preserved renal function were significantly younger (47.8 ± 2.5 years) than those without (58.5 ± 2.9 years) ( P = .01). Conclusion Renal function may be preserved in younger patients even if they do not achieve trifecta after partial nephrectomy for small renal masses.