PD18-06: Nephrometry scores predicting value of Trifecta achievement in a multicenter analysis (ROSULA database) of Robotic Partial Nephrectomy for totally endophytic deep renal masses

Gabriele Tuderti*, Riccardo Mastroianni, Umberto Anceschi, Alfredo Maria Bove, Aldo Brassetti, Mariaconsiglia Ferriero, Leonardo Misuraca, Salvatore Guaglianone, Rome, Italy, Riccardo Autorino, Richmond, VA, Jihad Kaouk, Cleveland, OH, Clayton Lau, Duarte, CA, Francesco Porpiglia, Turin, Italy, Ithaar Derweesh, Ava Saidian, Mimi Nguyen, San Diego, La Jolla, CA, Alexandre Mottrie, Aalst, Belgium, Andrea Mari, Florence, Italy, Manuela Costantini, Roma, Italy, Andrea Minervini, Florence, Italy, Michele Gallucci, Giuseppe Simone, Roma, Italy

Introduction: We recently presented a novel standardized Trifecta tool based on reproducible variables that is widely applicable to Robotic partial nephrectomy, regardless the clamping technique. In this study we assessed the performance of the two most adopted nephrometry scores, PADUA and RENAL, in predicting Trifecta achievement in a multicenter series of patients with totally endophytic “deep” renal tumors treated with Robotic Partial Nephrectomy.

Methods: Trifecta was defined as combination of negative surgical margins, no perioperative =3 Clavien complications and absence of significant eGFR decline (>30%). Chi-square test was used to assess Trifecta achievement according to PADUA and RENAL scores, respectively.Univariable and multivariable analysis were performed to identify predictors of Trifecta achievement.

Results: Overall, 341 consecutive patients with deep renal masses were included. Median PADUA and RENAL scores were 10 and 9, respectively.Low grade Clavien complications occurred in 49 patients (14.3%), high grade Clavien complication were observed in 14 patients (4.1%).Positive surgical margins were detected in 19 cases (5.5%).At a median follow-up of 24 months, median last eGFR was 71.5 ml/min, with a median last eGFR percent decrease of 10.4%.In this study, Trifecta was achieved in 77.7% of patients.Patients with high RENAL score displayed significantly lower probabilities of achieving trifecta (RENAL 6-8 vs 9-11: 89% vs 74.6%, p=0.009). On the contrary, PADUA score did not predict probability of Trifecta achievement (p=0.37).At multivariable analysis, RENAL score =9 was the only independent predictor of Trifecta achievement in patients with deep renal masses treated with robotic partial nephrectomy (OR=0.43, 95% CI: 0.19-0.97; p=0.04).

Conclusions: In this specific setting of totally endophytic deep renal masses, RENAL nephrometry score seems to be the only significant predictor of Trifecta achievement.

Source of Funding: none