Introduction: 3D virtual models (3DVMs) are nowadays under scrutiny to improve partial nephrectomy (PN) outcomes. Over the year, five different Trifecta definitions have been proposed to optimize the framing of “success” in the PN field. The aim of the present study was to analyze if the use of 3DVMs could impact the success rate of minimally-invasive PN, according to the currently available definitions of Trifecta. Methods: At our Institution 250 cT1-2N0M0 renal masses patients treated with minimally-invasive PN were prospectively enrolled. Inclusion criteria were the availability of contrast-enhanced CT from which a 3DVM was obtained, baseline and postoperative serum creatinine, and eGFR. These patients were then compared with a control group of 710 patients who underwent minimally-invasive PN with the same renal function assessments, but without 3DVMs. Trifecta rate was defined for each of the currently available definitions, after stratification according to 3DVMs availability. Multivariable logistic regression (MLR) models were used to predict the trifecta achievement according to the different trifecta definitions. Results: Overall, 960 patients met the inclusion criteria. Among the definitions, Trifecta rates ranged between 70.8% to 97.4% in the 3DVM group vs. 56.8% to 92.8% in the control group (all p values <0.05). 3DVMs showed better postoperative outcomes in terms of ?eGFR, (-16.6% vs. -2.7%, p=0.03), postoperative complications (15%, vs 22.9%, p=0.002) and major complications (Clavien Dindo >3, 2.8% vs 5.6%, p=0.03). At MLR 3DVMs assistance independently predicted higher rates of successful PN across all the available definitions of Trifecta (OR: 2.7 p<0.001, OR:2.0 p=0.0008, OR:2.8 p=0.02, OR 2.0 p=0.003). Conclusions: There was large variability in the rates of Trifecta according to different definitions, but always in favor of those PN assisted by 3DVMs. Their availability was found to be the constant predictive factor of successful PN, with a 2-fold higher probability of achieving Trifecta regardless of the different definitions available in Literature and justifying their introduction in clinical practice. SOURCE OF Funding: None
.jpg "Daniele Amparore, MD photo")