Abstract:

Objective To discuss the risk factors of renal function preservation and trifecta of the patients with renal cell carcinoma（RCC） after robot-assisted partial nephrectomy （RAPN）， and to provide the evidences for the preperative evaluation，postoperative treatment and long-term follow-up. Methods A retrospective analysis was conducted on the the clinical data of 111 cases of RCC patients undergoing RAPN.The patients were divided into trifecta group （n=73） and non-trifecta group（n=38） according to whether the trifecta outcome was achieved； according to the changes of 24 h etimated glomerular fltration rates（eGFR） before and after operation，the patients were divided into postoperative 24 h eGFR decreasing≤10% group（n=85） and postoperative 24 h eGFR decreasing>10% group（n=26）.The age， gender，American Society of Anesthesiologists（ASA） score， body mass index （BMI）， hypertension，diabetes，preoperative eGFR，percentages of postoperative 24 h eGFR change， hilar tumor，dorsal ventral positions of tumor，maximum tumor diameters， sugrical aproaches，warm ischemia time（WIT），intraoperative estimated blood loss （EBL），tumor pathological types，tumor TNM stages， RENAL scores， PADUA scores， central indexes （C-index）， renal tumor invasion indexes （RTII），and tumor contact area （CSA）of the patients in two groups were compared.Multivariate Logistic regression was used to analyze the influencing factors of the patients’ achievement of trifecta and the postoperative 24 h eGFR decreasing>10%. Multiple linear regression was used to analyze the influencing factors of the changes of postoperative 24 h eGFR. Results A total of 73 patients achieved trifecta among all the 111 patients.The univariate analysis results showed that there were statistically significant differences in age， hypertension， tumor maximum diameter， RENAL score， PADUA score， C-index， RTII， CSA，and EBL of the patients in trifecta group and non-trifecta group. The multivariate Logistic analysis results showed that EBL was an independent influencing factor for failing to achieve trifecta of the patients after RAPN（OR=1.006，95%CI=1.001—1.011，P=0.020）.There were statistically significant differences in tumor maximum diameters， RENAL scores， PADUA scores， C-indexes， RTII， CSA， WIT， EBL， and tumor TNM stages of the patients（P<0.05） in 24 h postoperative eGFR decreasing > 10% and postoperative 24 h eGFR decreaing ≤10% groups. The multivariate Logisitc regression analysis results showed that RTII was an independent influencing factor for the postoperative 24 h eGFR decreasing> 10% of the patients （OR=4.442，95%CI=1.049—18.806，P=0.043）.The tumor maximum diameter，RENAL，PADUA，C-index， RTII， CSA， WIT， EBL，and tumor TNM stage had no correlation with the postoperative eGFR changes； RTII had negative correlationship with postoperative 24 h eGFR changes（B=－7.204，95%CI=－14.305－－0.102，P=0.047）. Conclusion EBL is an independent influencing factor for failure to achieve trifecta outcomes of the patients after RAPN； RTII is negatively correlated with the postoperative 24 h eGFR changes.

Key words: Renal cell carcinoma, Partial nephrectomy, Renal function, Trifecta, Glomerular fltration rate