The limits of complex partial nephrectomy: are there any?

We read with great interest the recent publication by Beksac et al. that explored outcomes following robotic partial nephrectomy (RPN) for anatomically complex, defined as R.E.N.A.L. nephrometry score ≥10, cT1-cT2 renal masses (1). The authors aimed to determine the relationship between baseline clinicopathologic characteristics with “trifecta” achievement, defined as warm ischemia time <25 minutes, lack of perioperative complications, and negative surgical margins (1). Using a multi-institutional dataset, they found that the trifecta was achieved in 62% of patients and that no preoperative baseline, clinical, or tumor characteristics were associated with trifecta achievement. Interestingly, only pathologic tumor stage was significantly associated with achievement of trifecta. This manuscript contributes to the still developing literature for the important topic regarding the role of partial nephrectomy for large and complex renal masses.