Journal of Urology and Renal Diseases

Volume: 2017; Issue: 05
6 Nov 2017

Prediction of The Trifecta And Pentafecta İn Minimal İnvasive Partial Nephrectomy


Deniz Bolat*, Bulent Gunlusoy

*Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey

*Corresponding author: Deniz Bolat, Department of Urology, Bozyaka Training and Research Hospital, Karabaglar, Izmir, Turkey; Tel: +905056383010; E-mail:

Received Date: 06 January, 2017; Accepted Date: 09 January, 2017; Published Date: 16 January, 2017




Suggested Citation



In the treatment of small renal masses which are incidentally diagnosed by sophisticated imaging techniques, partial nephrectomy (PN) is the gold standard treatment  with oncologic equivalence, functional superiority and improved overall  survival compared with radical nephrectomy [1]. Over the years, surgery has met the long life expectancy of patients and functional outcomes has become the main subject to pay attention in the selection of treatment modality. ‘Trifecta’ is the term for describing the achievement of no complications, negative surgical margin, warm ischemia time (WIT)< 25 min is the key surrogate for success of the PN [2].


Hung et al  stated  that  trifecta  should  be  a  routine  goal  during  PN  surgery   and  despite  increasing  tumor  complexity, the  trifecta  outcome  of  oncological  success, low  urological  complications  and  preserved  renal  function  has  improved  significantly [2].The functional results of the PN are influenced by numerous factors including baseline patient characteristics, operation techniques, surgical experience, defination of WIT, and methods used to collect data. Osaka et al assessed  trifecta  outcomes  for  laparoscopic  PN  for  clinical  T1a  renal  masses  and  concluded  that  tumor  size  and  surgeon’s  learning  curve  were  strong  predictors  of  trifecta outcomes [3].


In a recent study, Zargar et al investigated the effects of ‘trifecta’ and MIC (no major perioperative complications, negative surgical margins and WIT<20 min)  on the functional outcomes of PN, and  emphasized  that  achievement of  both  MIC  and  ‘trifecta’  is  associated  with  higher  proportion  of  split  renal  function  preservation  for  cT1  tumors  after  minimally  invasive  PN [4].
Zargar et al  reported that  their more strict definition for ‘optimal outcome’ might be a better tool for assessing perioperative and functional outcomes after minimally invasive PN and  introduced  ‘Pentafecta’ term [5]. The ‘optimal outcome’ was defined as achievement of ‘trifecta’  with addition of 90% estimated glomerular filtration rate preservation and no chronic kidney disease stage upgrading [5]. Conditions, such  as  diabetes, hypertension and chronic kidney disease could  potentially effect on the functional outcomes after PN. Considering all patients underwent surgery by high-volume surgeons, the modifications in the operative technique  also  affects  the  functional  outcomes.

We  believe  that  tumor  size  and  the  degree  of  complexity  with   surgical experience  are  significant  predictors  of  trifecta and pentafecta achievement.  However, for the prediction of trifecta and pentafecta in minimally invasive PN, a validated nomogram which including all the aforementioned variables is required.



Keywords: Functional outcomes; Minimally invasive surgery; Partial nephrectomy;Renal mass; Trifecta


Conflict of interest: The authors declare that they have no conflict of interest.

Suggested Citation


Citation: Bolat D, Gunlusoy B (2017) Prediction of the trifecta and pentafecta in minimal invasive partial nephrectomy. J Urol Ren Dis 2017: G122. DOI: 10.29011/2575-7903.000022

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