Investigate The Influencing Factors Of Renal Function Preservation And Trifecta In Patients After Robot-assisted Laparoscopic Partial Nephrectomy

Objective:To explore the risk factors of renal function preservation and trifecta after robot-assisted partial nephrectomy(RAPN)for renal cancer,and to provide evidence for postoperative treatment and long-term follow-up.Methods:Retrospective analysis of the clinical data of 111 cases of renal cancer patients undergoing robot-assisted partial nephrectomy in the first hospital of Jilin university.Patients were divided into Trifecta group and Non-Trifecta group according to whether or not they had achieved a trifecta.Patients were divided into two groups with a decreased of less than 10%and a decreased of more than 10%according to the postoperative 24h eGFR changes.using SPSS software by Mann-Whitney U test,chi-square test and two independent-sample T-test analysis between group differences.Multivariate Logistic regression was used to analyze the risk factors affecting patients’ achievement of a trifecta and a decreased of more than 10%in postoperative 24h eGFR changes.Multiple linear regression was used to analyze the factors affecting the postoperative 24h eGFR changes.Results:The median change of eGFR at 24 hours after surgery in 111 patients was-2.16%,and a total of 73 patients(65.8%)achieved trifecta.In univariate analysis,there were statistically significant differences in age,hypertension,tumor maximum diameter,RENAL,PADUA,centrality index(C-index),tumor invasion index(RTⅡ),tumor contact area(CSA),and estimated intraoperative blood loss(EBL)among thetrifecta groups(P<0.05).Multivariate Logistic analysis showed that EBL was an independent risk factor for PN failing to achieve trifecta(B=0.006,OR=1.006,95%CI=1.001-1.011,P=0.020).There were statistically significant differences in tumor maximum diameter,RENAL,PADUA,C-index,RTII,CSA,WIT,EBL,TNM stage(P<0.05)when eGFR decreased more than 10%at 24 hours after operation.Multivariate Logisitc regression analysis showed that RTII was an independent risk factor for eGFR decline greater than 10%at 24 hours after surgery(B=1.491,OR=4.442,95%CI=1.049-18.806,P=0.043).Univariate linear regression analysis showed that tumor maximum diameter,RENAL,PADUA,C-index,RTII,CSA,WIT,EBL,TNM stage were linearly correlated with postoperative eGFR changes(P<0.05).Multiple linear regression analysis suggested that RTII was an independent risk factor for eGFR changes at 24 hours after surgery(B=-7.204,95%CI=-14.305--0.102,P=0.047).Conclusion:Intraoperative estimated blood loss(EBL)can be used in RAPN to predict the achievement of postoperative trifecta.The preoperative renal tumor invasion index(RTII)can be used to predict postoperative renal function loss...