Considering "Trifecta" as a Single Outcome when Comparing Robotic With Open Partial Nephrectomy: A Mathematical Model of Volume Conservation and Systematic Review.

BACKGROUND/AIM: Trifecta represents a composite outcome reflecting the quality level of treatment in nephron sparing surgery. However, there is substantial heterogeneity concerning the criteria required for its fulfilment. The present study aimed to highlight the potential of a unified view for the different definitions of trifecta when comparing robotic and open approaches in partial nephrectomy. MATERIALS AND METHODS: A systematic literature search was carried out for all relevant comparative studies published until April 2022. Trifecta definitions were clustered according to two criteria for postoperative renal function reduction. The first set as an upper limit the 10% decrease in the estimated glomerular filtration rate, while the second set as an upper limit 25 min of ischemia. To mathematically investigate the point of intersection between the above two groups, a suitable model of volume conservation equations was formulated. RESULTS: A total of 11 studies were investigated for their methodological features and grouped accordingly. The ischemic zone volume surrounding the tumor resection site emerged as the central parameter connecting the two main definitions. Specifically, for patients with solitary renal masses, a given change in the value of one parameter resulted in a fixed change in the value of the other. CONCLUSION: The two main definitions of the "trifecta outcome" extracted from the international literature represent the two sides of the same coin. Thus, trifecta achievement rates could be utilized by future studies as aggregate data to yield a quantitative estimate of the comparative effect between robotic and open approaches in partial nephrectomy procedures.

Sporadic versus inflammatory bowel disease-related colorectal adenocarcinoma: lessons learned from a single institution experience.

PURPOSE: Inflammatory bowel disease (IBD) - related colorectal adenocarcinoma (CAC) is known to impose a less favorable prognosis than its sporadic counterpart. The determining factor in the prognosis of IBD patients is the early endoscopic detection of commonly occult pre-cancerous lesions. This retrospective study attempted to highlight the distinctive features of IBD-related CAC, as well as the importance of implementing an acceptable surveillance protocol in IBD patients. METHODS: The medical records and biopsies of all IBD patients undergoing surgery and of surgical patients with sporadic CAC, admitted in the 5-year period 2010-2014, were examined. Overall, 26 clinicopathological parameters were collected and compared between the two groups. RESULTS: A total of 370 patients with sporadic CAC and 103 patients with IBD were included in the study, of which 8.7% (9/103) proved to have CAC. Cancer in IBD patients appeared at a younger age, had a larger maximum diameter and was more likely to have multiple synchronous locations and a signet-ring cell differentiation (p<0.05). Only 25% of IBD patients with CAC had previously followed correct surveillance. CONCLUSIONS: The aggressive features of IBD-related CAC, as well as the rising incidence of poorly-surveilled IBD patients that eventually progress to cancer, reflect the necessity of establishing dedicated IBD centers for their optimal follow-up.