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Background <p>Laparoscopic partial nephrectomy (LPN) remains technically challenging for complex renal masses, and there are limited data regarding its safety and efficacy. This study aims to compare the perioperative outcomes of LPN for complex renal masses with RENAL nephrometry score ≥ 7 vs. simple renal masses with RENAL score &lt; 7, focusing on achieving the "Trifecta" outcome.</p> Materials and methods <p>We retrospectively analysed data from 170 patients who underwent LPN for malignant renal masses between 2017 and 2021. Patients were divided into Group A (score &lt; 7) and Group B (score ≥ 7) based on RENAL score. Demographics, blood parameters, renal mass characteristics, surgical details, and pathology findings were compared. Perioperative outcomes were assessed based on Trifecta criteria: negative pathological surgical margin (PSM), warm ischemia time (WIT) ≤ 25&#xa0;min, and no &gt; grade 2 Clavien–Dindo complications.</p> Results <p>Group A and Group B comprised 88 (51.7%) and 82 (48.2%) patients, respectively. Trifecta outcomes were comparable between Group A (68.1%) vs. Group B (62.2%) (<i>p</i> = 0.5). There was no significant difference in patients with WIT ≤ 25&#xa0;min (77.2% vs. 78%, <i>p</i> = 0.88) and negative PSM (92% vs. 86.5%, <i>p</i> = 0.19). The incidence of major complications was low overall but significantly higher for Group B (9.7%) vs. Group A (2.2%), <i>p</i> = 0.04. Perioperative glomerular filtration rate drop (17.2 vs.16.1, <i>p</i> = 0.66), estimated intraoperative Hb drop (2.1 vs. 2.09, <i>p</i> = 0.15) gm%, mean blood loss (180 vs. 221&#xa0;ml, <i>p</i> = 0.9) and mean operation time (135 vs. 120&#xa0;min, <i>p</i> = 0.64) did not significantly differ between Group A vs. Group B, respectively.</p> Conclusions <p>LPN is a safe approach for managing complex renal masses, yielding acceptable overall Trifecta outcomes when performed by experienced surgeons in high-volume centers. However, surgeons should be cognizant of the increased risk of positive surgical margins and postoperative complications in tumours with a RENAL score greater than or equal to 7.</p>

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Comparison of trifecta outcomes for laparoscopic partial nephrectomy between simple and complex renal masses: a retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月12日

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  • Arnab Mitra,
  • Sadanala Madhuri Evangeline,
  • A. J. P. George,
  • Partho Mukherjee,
  • Mahasampath Gowri,
  • Santosh Kumar,
  • Thampi John Nirmal

摘要

Background

Laparoscopic partial nephrectomy (LPN) remains technically challenging for complex renal masses, and there are limited data regarding its safety and efficacy. This study aims to compare the perioperative outcomes of LPN for complex renal masses with RENAL nephrometry score ≥ 7 vs. simple renal masses with RENAL score < 7, focusing on achieving the "Trifecta" outcome.

Materials and methods

We retrospectively analysed data from 170 patients who underwent LPN for malignant renal masses between 2017 and 2021. Patients were divided into Group A (score < 7) and Group B (score ≥ 7) based on RENAL score. Demographics, blood parameters, renal mass characteristics, surgical details, and pathology findings were compared. Perioperative outcomes were assessed based on Trifecta criteria: negative pathological surgical margin (PSM), warm ischemia time (WIT) ≤ 25 min, and no > grade 2 Clavien–Dindo complications.

Results

Group A and Group B comprised 88 (51.7%) and 82 (48.2%) patients, respectively. Trifecta outcomes were comparable between Group A (68.1%) vs. Group B (62.2%) (p = 0.5). There was no significant difference in patients with WIT ≤ 25 min (77.2% vs. 78%, p = 0.88) and negative PSM (92% vs. 86.5%, p = 0.19). The incidence of major complications was low overall but significantly higher for Group B (9.7%) vs. Group A (2.2%), p = 0.04. Perioperative glomerular filtration rate drop (17.2 vs.16.1, p = 0.66), estimated intraoperative Hb drop (2.1 vs. 2.09, p = 0.15) gm%, mean blood loss (180 vs. 221 ml, p = 0.9) and mean operation time (135 vs. 120 min, p = 0.64) did not significantly differ between Group A vs. Group B, respectively.

Conclusions

LPN is a safe approach for managing complex renal masses, yielding acceptable overall Trifecta outcomes when performed by experienced surgeons in high-volume centers. However, surgeons should be cognizant of the increased risk of positive surgical margins and postoperative complications in tumours with a RENAL score greater than or equal to 7.