Renal functional and surgical outcomes after robot-assisted partial nephrectomy for hilar vs non-hilar tumors: Trifecta and pentafecta evaluation

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BACKGROUND Robot-assisted partial nephrectomy (RAPN) is well-suited for managing complex renal tumors, including those located in the renal hilum. However, studies directly comparing RAPN outcomes for hilar and non-hilar tumors, particularly in terms of comprehensive measures, such as trifecta and pentafecta, are still limited. AIM To evaluate whether tumor location in the renal hilum independently influences surgical and renal functional outcomes after RAPN, as assessed by trifecta and pentafecta criteria. METHODS This single-center retrospective cohort study evaluated outcomes of RAPN for hilar and non-hilar renal tumors treated from April 2016 to June 2023. Eligible patients had tumors ≤ 7 cm, no metastasis, and at least one year of follow-up. Propensity score matching was applied. Primary endpoints were trifecta and pentafecta achievement. All procedures were performed under ischemia without early unclamping. Multivariate logistic regression identified predictors of outcome achievement. RESULTS Of 350 patients, 324 met the inclusion criteria, consisting of 60 hilar and 264 non-hilar tumors. Trifecta achievement was similar between hilar (63.3%) and non-hilar groups (64.0%), with no significant differences in ischemia time, positive margins, or major complications. Pentafecta achievement rates were also similar (20.0% hilar vs 14.0% non-hilar, P = 0.237). Multivariate analysis identified R score, N score, and L score as predictors of pentafecta non-achievement. Surgeon experience and hilar tumor presence were predictors of pentafecta achievement. Hilar tumor location was not an independent determinant in the propensity-matched analysis, suggesting that the adjustment methods and sample size may have influenced the results. CONCLUSION RAPN achieved comparable trifecta and pentafecta outcomes for hilar and non-hilar tumors, supporting its viability for complex hilar tumors when appropriate patient selection and surgical experience are ensured.