Trifecta Outcomes in Multifocal Tumors: A Comparison Between Robotic and Open Partial Nephrectomy.

Objectives: To report a comparative analysis of outcomes in patients who underwent multiple excisions for unilateral synchronous multifocal renal tumors using both open and robotic approaches. Methods: We retrospectively reviewed 110 patients who underwent robotic and open partial nephrectomy and had multiple tumor excisions in an ipsilateral kidney. Trifecta was defined as negative surgical margins, no urologic complications, and a glomerular filtration rate (GFR) preservation of 90% at last follow-up. Inverse probability of treatment weighting (IPTW) was applied to equilibrate treatment groups, minimize selection bias, and optimize inference on the basis of each patient's clinicodemographic characteristics. Results: Sixty-eight robotic and 42 open patient approaches had sufficient data for IPTW. After weighting, there were no statistical differences in baseline characteristics between the two groups. On adjusted analyses, robotic partial nephrectomy achieved equivalent rates of trifecta to open surgery (16.3% vs 16.5%, p=0.99), which persisted on subgroup analyses of patients with two (20.1% vs 23.7%, p=0.82) or more than two tumors (6.8% vs 7.4%, p=0.95). There were no differences between robotic and open cohorts for negative margin rates, absence of complications, or GFR 90%. The robotic cohort had a shorter mean length of stay (3.4 vs 4.9 days, p<0.001). Conclusions: Surgical resection remains the mainstay for patients with unilateral, synchronous, and multifocal renal tumors. Our analysis found that both open and robotic approaches to partial nephrectomy are equally likely to achieve the trifecta outcome in an equilibrated high-risk group of patients. The robotic approach for these complex patients may be safe and feasible for a carefully selected group of patients.