ENDOSCOPIC ROBOT-ASSISTED SIMPLE ENUCLEATION (ERASE) VS OPEN SIMPLE ENUCLEATION (OSE) FOR THE TREATMENT OF CLINICAL T1 RENAL MASSES: ANALYSIS OF PREDICTORS OF TRIFECTA OUTCOME

Scopo del lavoro The aim of this study is to analyse the intra and postoperative complications and the predictive fac-tors of Trifecta outcome in patients submitted to ERASE and OSE for clinical T1 renal masses. Materiali e metodi Overall 634 cases treated with OSE (n=290) and ERASE (n=344) were prospectively recorded in our department between 2006 and 2014. Trifecta was defined as simultaneous ischemia time <25 min, no surgical complication and negative surgical margin. A univariate analysis and multivariate logistic regression were performed for Trifecta Risultati The two groups were comparable for BMI, comorbidity, tumor side, clinical T score, tumor diame-ter, surgical indication, preoperative renal function, preoperative hemoglobin and hematocrit. A significant difference was found between the OSE and the ERASE groups in operative time (115 (96-130) vs 150 (120-180) minutes, p<0.0001), pedicle clamping (93.8% vs 69.2%, p<0.0001), es-timated blood loss (EBL) (150 (100-200) vs 100 (100-143) cc, p<0.0001) and intraoperative compli-cations (3.4% vs 1.7%, p=0.02). The two groups were comparable for WIT >=25 min. A significant difference was found between OSE and ERASE in overall (16.6% vs 5.5%, p<0.0001), Clavien 2 (11.7% vs 4.4%, p=0.02) and Clavien 3 (3.1% vs 1.7%, p=0.04) postoperative surgical complications, length of stay (6.0 (5.0-7.0) vs 5.0 (4.0-6.0) days, p<0.0001), preoperative -1st day delta creatinine (0.3 (0.2-0.4) vs 0.15 (0.1-0.2) mg/dL, p<0.0001), positive surgical margins (2.1% vs 1.5%,p=0.04), and Trifecta achievement (73.8% vs 85.5%, p<0.0001). At univariable analysis, a higher median clinical diameter, a higher mean age, a higher median Charlson comorbidity index (CCI), endophytic tumor growth pattern, renal sinus and caliceal dislo-cation of the tumor, a higher median PADUA score and OSE were predictive factors of Trifecta achievement. At multivariable analysis, CCI lost significance (p=0.26), while age (OR: 1.02, IC95%:1.00-1.04, p=0.001), clinical diameter (OR: 1.22, IC: 1.05-1.42, p=0.008), PADUA score (OR: 1.23, IC: 1.07-1.41, p=0.004) and OSE (OR: 1.74, IC: 1.13-2.68, p=0.01) were confirmed predictive factors for Trifecta failure. Discussione The ERASE is a feasible and safe technique, which shows a comparable WIT, together with a sig-nificantly lower EBL, surgical complications rate, length of stay and a significantly higher Trifecta achievement compared to OSE. Conclusioni Age, comorbidity, tumor diameter and PADUA score, in association with surgical approach repre-sent significant predictive factors of Trifecta failure.