Current Role of Pentafecta Outcomes in Open and Laparoscopic Partial Nephrectomy for Localized Renal Tumors

Partial nephrectomy (PN) is widely considered the preferred treatment for clinical T1 (cT1) renal masses, primarily because it preserves kidney function more effectively than radical nephrectomy.

The trifecta metric includes three components: warm ischemia time (WIT) of ≤ 25 minutes or cold ischemia time (CIT) of ≤ 60 minutes, negative surgical margins, and the absence of perioperative major complications. The pentafecta expands upon these criteria by adding two additional parameters: preservation of ≥ 90% of the estimated glomerular filtration rate (eGFR) and no progression in chronic kidney disease (CKD) stage within 12 months postoperatively.

Inclusion criteria

• Age ≥ 18 years.
• Both sexes.
• Patients who diagnosed with clinical T1 or T2a N0M0 renal tumors who were suitable candidates for partial nephrectomy

Exclusion criteria

• Severe and irreversible coagulopathy.
• Anatomically unfavorable tumor location.
• Extensive encasement of the renal pedicle.
• Diffuse invasion of the renal vein or central collecting system.
• Adjacent organ invasion consistent with stage cT4 disease.
• Regional lymphadenopathy (stage cTxN1), or anticipated retention of less than 20% of total nephron mass.