Background: This study aimed to compare the outcomes of open partial nephrectomy (OPN) and robot-assisted partial nephrectomy (RAPN) based on preoperative risk assessment using Martini's nomogram and postoperative trifecta and pentafecta criteria.
Methods: We retrospectively reviewed patients who underwent OPN or RAPN between 2017 and 2021. Renal function was assessed pre- and postoperatively using estimated glomerular filtration rate (eGFR) calculated by the Cockcroft-Gault formula. Baseline renal function was defined in accordance with the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The Martini's nomogram was used preoperatively to estimate the risk of >25% postoperative eGFR decline; Surgical outcomes were evaluated in accordance with trifecta and pentafecta criteria.
Results: A total of 103 patients were included (OPN: 63; RAPN: 40). The median follow-up was 77 (65-87) months. Median warm ischemia time was significantly lower in the OPN group (20 vs. 27.5 min, p < 0.001). Trifecta and pentafecta achievement rates were higher in the OPN group (65% vs. 25%, p < 0.001; 30.1% vs. 10%, p < 0.05, respectively). Martini's nomogram showed good discrimination in OPN (area under the curve (AUC) = 0.87) and RAPN (AUC = 0.80). Calibration analyses indicated overestimation in the OPN high-risk stratum, whereas the RAPN high/very-high strata were consistent with predictions.
Conclusions: In this retrospective cohort, OPN was associated with higher trifecta and pentafecta achievement than RAPN. The Martini's nomogram showed good discrimination but procedure-dependent calibration: Strata-level predictions aligned in RAPN, whereas risk was overestimated in the OPN high-risk stratum. These findings support cautious use for risk ranking and underscore the need for procedure-specific recalibration and further external validation, particularly for OPN.
Keywords: nephrectomy; pentafecta; robot-assisted; trifecta.
© 2025 The Author(s).