PREDICTIVE FACTORS OF SURGICAL COMPLICATION, ISCHEMIA TIME AND TRIFECTA OUTCOME IN CT1B RENAL MASSES. REPORT OF A MULTICENTRIC INTERNATIONAL PROSPECTIVE STUDY

Scopo del lavoro This study reports a multicentre international prospective dataset of NSS performed in cT1b renal tumors. The aim of this study is to compare different approaches in NSS of cT1b renal masses and to analyse predictive factors of surgical complications and trifecta outcomes. Materiali e metodi In this series 262 cases performed in 23 centres were prospectively analysed. Patients were treated in low and high volume centres (defined as < or ≥ 50 per year NSS). Trifecta was defined as simultaneous ischemia Risultati A median clinical tumor diameter of 5 (4.4-5.5) cm was reported. 36.6% lesions presented a 25 min ischemia time. Surgical complications were 17.9%, surgical Clavien 2 and 3 were 9.2% and 5.0%, respectively. Positive surgical margin were registered 6.9% of patients. Trifecta was achieved 58% patients. Open approach was performed in 37.8% of cases, video laparoscopic approach (VLP) in 21.8% of cases and robotic approach (RAPN) in 40.4% of cases. Three groups presented similar preoperative features. Open, VLP, and RAPN were performed in high-volume centres in 61.6%, 93.0% and 100% of cases, respectively, p=0.001. Three groups presented significant difference in ischemia time values (16 (14-20) vs 24 (20-28) vs 22 (18-27) mins, respectively. P=0,01). A significant difference in medical complications was found between three groups (13.1% vs 1.8% vs 1.9%. p>0,001). No significant difference was found between three groups in overall, clavien 2 and 3 surgical complications, positive surgical margins, preoperative-3rd day delta haemoglobin and eGFR. At uni and multivariate analysis mediorenal location (OR 2.90, p 0.001) and estimated blood loss (EBL) (OR 1.0, p 0.001) were predictive factors of overall surgical complication. At univariate analysis, significant factors for trifecta negative outcome were endophytical growth pattern (p=0.04) and high EBL (p Discussione NSS seems a feasible technique for cT1b renal masses, but it still presents a high rate of surgical complications. A minimally invasive (both VLP and robot assisted) approach can be used in experienced centres, without risk of complication and low term renal function impairment. High bleeding during the procedure and mediorenal lesions are predictive factors of surgical complications. High bleeding and endophytical lesion are predictive factors of trifecta negative outcome. Conclusioni This paper has the worship of a simultaneous comparison of outcomes in different approaches in NSS in cT1b renal masses.