The current role of pentafecta outcomes in open and laparoscopic partial nephrectomy for localized renal tumors

Abstract

Background: Partial nephrectomy (PN) is the standard treatment for managing clinical T1 renal masses. The "trifecta" and "pentafecta" metrics are commonly used to assess the complexity and success of PN procedures. The present study aimed to identify predictive factors associated with the achievement of pentafecta outcomes following PN. Methods. A prospective randomized study was conducted between May 2022 and May 2024, involving 70 patients with clinical T1–T2a N0M0 renal tumors suitable for partial nephrectomy. Participants were randomly assigned into two groups: Group A (n = 38) underwent open partial nephrectomy (OPN), and Group B (n = 32) underwent laparoscopic partial nephrectomy (LPN). Preoperative assessment included lab tests and imaging. All surgeries were performed via a transperitoneal approach under general anesthesia. OPN and LPN techniques followed standardized protocols, each performed by an experienced surgeon. Postoperative follow-up included clinical, laboratory, and imaging assessments at set intervals. Primary outcomes focused on predictors of pentafecta achievement; secondary outcomes included blood loss, operative time, hospital stay, pain scores, complications, recurrence, and renal function. Statistical analysis was performed using SPSS v26.0, with significance set at p < 0.05. The study was registered at ClinicalTrials.gov (Identifier: NCT06960135). Results. Both surgical approaches yielded comparable oncological outcomes. However, patients in the LPN group experienced significantly lower intraoperative blood loss, shorter operative times, reduced opioid requirements, and lower postoperative pain scores (p < 0.05) compared to the OPN group. Additionally, the length of hospital stay was significantly shorter in the LPN group (p < 0.0001). A significant positive association was observed between glomerular filtration rate and the use of tumor enucleation (p = 0.0073), as well as between PADUA score and body mass index (p = 0.0004). Conclusions. While LPN is associated with longer ischemia time, it offers significant benefits over OPN, including reduced blood loss, lower analgesia requirements, and shorter hospital stays.