Laparoscopic/ Robotic: Other

Moderated Poster Session

MP16-20 - Laparoscopic partial nephrectomy in patients with pT1a and pT1b renal cell carcinoma: Strict Trifecta outcomes.

Saturday, September 22
10:00 AM - 12:00 PM
Location: Room 243

Introduction & Objective :

The “Trifecta", the term for describing the achievement of no postoperative complications (Clavien-Dindo≥2), negative surgical margins and warm ischemia time (WIT) ≤25 minutes, is the key surrogate for success of the laparoscopic partial nephrectomy (LPN).

The objective is to examine the perioperative outcomes following LPN in patients with pT1a-pT1b renal cell carcinoma (RCC) and to identify the predictors of Trifecta achievement following LPN.

Methods :

We retrospectively analyzed the data of 97 patients with RCC, who underwent LPN between January 2008 and September 2017, with a median follow up time of 46.5 months, performed by a single surgeon in his learning curve. LPN was performed via transperitoneal approach.

LPN for renal mass < 7 cm were included in this study (82.5% pT1a and 17.5% pT1b). Preoperative, intraoperative and postoperative data were recorded and analyzed to evaluate short-term functional and oncologic outcomes. Univariate and multivariate analysis was performed using logistic regression, including variables with statistical significance (p<0.05) and a tendency to significance (p≤0.11), which might influence as predictors of the Trifecta outcomes.

Results :

56.7% of the patients were men, with a median age of 63 years. Mean tumor size was 30.6 mm (10-70) and median nephrometry score according to PADUA was 9, with 75% of patients with high complexity..

Mean operative time and estimated blood loss were 184.76 minutes and 407.8 ml respectively. Median WIT was 19 minutes, with statistically significant differences between pT1a and pT1b tumors(p=0.015). Overall rate of intraoperative and postoperative complications were 21.7 and 48.5% respectively, although major complications (Clavien ≥3) were only described in 21.3% of all the complications.

The rate of Trifecta achievement was 62%. In univariate analysis, previous abdominal surgery (p=0.09), ASA ≥3 (p=0.03), tumor size of 4.1-7 (p=0.1) with interpolar (p=0.014) or hiliar localization (p=0.04) and high tumor complexity (PADUA>9) (p=0.06) were identified as variables related to Trifecta. In the multivariate analysis, only ASA ≥3 (p=0.03), hiliar localization (p=0.041) and high tumor complexity (p=0.04) behaved as prognostic variables for the achievement of Trifecta. Patients with T1a tumors did not show higher rates of Trifecta compared to those with T1b tumors (62.5% vs 58.8%, p=0.9).

Conclusions :

In this study, we obtain a Trifecta rate similar to that observed in other series. The anesthetic risk ASA ≥3, hiliar localization and high tumor complexity (PADUA>9), appear to be predictive factors for Trifecta achievement following LPN.


Gema Del Pozo Jiménez

Staff Urologist
University Hospital Puerta de Hierro, Majadahonda.

- 2003-2009: Doctor of Medicine and Surgery (MD). University of Alcalá, Madrid, with a final grade of Honours.
- 2010-2015: Urology Residency. General University Hospital Gregorio Marañón, Madrid.
- 2013-2017: Degree in Design and Statistics in Health Sciences. Autonoma University of Barcelona.
- November, 2014: European Board of Urology (EBU) Online Written Examination. Madrid.
- June, 2015: European Board of Urology (EBU) Oral Examination. Brussels.
- 2013-2017: PhD. Complutense University of Madrid with mention of "Cum laude" with the title: Predictive model of mortality in patients with transitional bladder cancer treated with radical cystectomy.
- October 2017: Enrollment in the Master in Health Research Methodology. Autonoma University of Barcelona.
- January-May 2018: University Title of Expert in Urooncology of the Autonoma University of Madrid,
- Currently working as FEA of Urology since June 2015 in Puerta de Hierro University Hospital (Majadahonda), as well as a private activity in H.U. La Zarzuela and H. University H.M. Torrelodones.
• Practical teaching in the subject of Urology of the Autonoma University of Madrid in H.U.Puerta de Hierro (2015-2018).
• Online teaching as a professor in the course of laparoscopic and robotic radical cystectomy (1st Edition) of the European School of Urological Laparoscopy (2018).
3.-PUBLICATIONS IN JOURNALS: Five publications as author, four publications as co-author (three in Spanish Archives of Urology and one chapter of the Urology Resident's Book (Internet)) and four abstracts of European and world congresses, three as author and one as co-author (European Urology Supplements and Journal of Endourology).
4- COMMUNICATIONS PRESENTED AT NATIONAL CONGRESS: As author 32 papers: Eighteen papers and as co-author 36 co-author papers.
5- SUBMITTED VIDEOS IN CONGRESS: 14 videos as author and 6 videos as co-author.
6-COMMUNICATIONS/VIDEOS PRESENTED AT INTERNATIONAL CONGRESS: As author (9 presentations) and as co-author (4 presentations).


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    Jorge Turo-Antona

    University Hospital Puerta de Hierro, Majadahonda.

    Jorge Turo Antona
    Especialista en Urología
    Facultativo Especialista en el Servicio de Urología del Hospital Universitario Puerta de Hierro de Majadahonda (Madrid)


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      Javier Sáenz-Medina

      University Hospital Puerta de Hierro, Majadahonda.


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        Martin Parini

        Staff UROLOGIST
        Hospital Español de Buenos Aires


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          Ignacio T. Castillón Vela

          Staff urologist
          H.U. Puerta de Hierro. Majadahonda

          Consultant Urologist. Department of Urology.
          Hospital Universitario Puerta de Hierro Majadahonda
          H.U. Madrid Torrelodones.
          Escuela Europea de Laparoscopia Urológica. Madrid

          1984-1990 Doctor of Medicine. Universidad Autónoma de Madrid
          1992-1997 Urology Residency. Department of Urology. Fundación Jiménez Díaz. Madrid.
          1998. Certificate. Educational Comission for Foreign Medical Graduates (ECFMG).
          2/1999- 1/2001 Clinical Fellow in Kidney and Pancreas Tansplantation
          National Institute of Transplantation - St Vincent Medical Center. Departament of Urology. University of Southern California (USC). Los Ángeles, California. EEUU.
          2001 PhD in Medicine and Surgery. Universidad Autónoma de Madrid.
          2005-2006 Master in Medical Direction and Clinical Management Universidad Nacional de Educación a Distancia (UNED)
          2008 University Expert Certificate in “E learning 2.0: Internet Education and On line training". Universidad Nacional de Educación a Distancia (UNED)
          2009 Accreditation as Da Vinci Robot Console Surgeon.

          Editor of 4 Books
          Author in 5 chapters in urological Books
          Editor/Author of 9 Audiovisual Projects
          27 Articles in indexed Journals
          85 Panel Presentations in Urological Meetings
          114 Podium/Poster/Video presentations at urological meetings.

          Reviewer for the following Journals:
          - Archivos Españoles de Urología
          - Urology
          - Journal of Endourology
          Reviewer for the selection commitee:
          - Spanish AEU Annual Meeting
          - European Association of Urology (EAU) Annual Meeting


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            MP16-20 - Laparoscopic partial nephrectomy in patients with pT1a and pT1b renal cell carcinoma: Strict Trifecta outcomes.

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