OBJECTIVE The objective of this study was to evaluate the early surgical outcomes of robot-assisted partial nephrectomy (RAPN) for small renal masses in a large Japanese multicenter series. METHODS A total of 804 consecutive cases of RAPN were examined at 42 institutes between 2011 and 2016. Medical records for clinical, pathological characteristics and perioperative outcomes were retrospectively reviewed. Univariable and multivariable analyses were performed to determine factors predicting Trifecta achievement. RESULTS The median tumor size was 2.6 cm. The median RENAL score was 7. The median warm ischemia time was 21 min. The median estimated blood loss was 30 mL. Eight patients (1.0%) were converted to radical nephrectomy. The overall and Clavien-Dindo grade ≥ 3 complication rates were 13.0% and 5.8%, respectively. Pathologically, 91.4% of tumors were malignant and the positive surgical margin (PSM) rate was 1.1%. During the median 27.1-month observation period, the recurrence rate was 1.6%. Postoperative preservation rates of eGFR at 1, 6, 12 and 24 months were 90.3, 89.8, 89.4 and 89.2%, respectively. Trifecta was achieved in 62.1%. Multivariable analysis demonstrated that tumor diameter, estimated blood loss and hilar location of the tumor were significant negative factors predicting Trifecta achievement. The rate of Trifecta achievement for T1b tumors and hilar tumors was significantly lower (48.4% and 50.0%, respectively). CONCLUSIONS RAPN was safely performed with acceptable oncological and functional outcomes, but the rate of Trifecta accomplishment for T1b or hilar tumors was significantly lower than that for T1a or non-hilar tumors, respectively.

中文翻译：

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机器人辅助部分肾切除术的“ Trifecta”结局：一项大型的日本多中心研究。

目的本研究的目的是评估日本大型多中心研究中机器人辅助部分肾切除术（RAPN）对小肾脏肿块的早期手术效果。方法回顾性分析2011年至2016年间42所研究所共804例RAPN连续病例的临床，病理特征和围手术期结局。进行单变量和多变量分析以确定预测三连胜成就的因素。结果中位肿瘤大小为2.6 cm。RENAL评分中位数为7。温暖缺血时间中位数为21分钟。中值估计失血量为30毫升。8例（1.0％）患者接受了根治性肾切除术。总体和Clavien-Dindo≥3级并发症发生率分别为13.0％和5.8％。从病理上来说91。4％的肿瘤是恶性的，手术切缘阳性率（PSM）为1.1％。在中值27.1个月观察期内，复发率为1.6％。术后1、6、12和24个月eGFR的保存率分别为90.3％，89.8、89.4和89.2％。三连胜达到62.1％。多变量分析表明，肿瘤直径，估计的失血量和肿瘤的肺门位置是预测Trifecta成就的重要负面因素。T1b肿瘤和肝门肿瘤的Trifecta成功率显着较低（分别为48.4％和50.0％）。结论RAPN可以安全地进行，具有可接受的肿瘤学和功能性结局，但T1b或肺门肿瘤的Trifecta完成率分别显着低于T1a或非肺门肿瘤。