The Usefulness of Martini’s Nomogram and the Evaluation of Trifecta and Pentafecta Criteria in Renal Cancer: A Comparison of Open and Robot-Assisted Partial Nephrectomy

• Sinharib Çitgez ^[3] ; Mehmet Hamza Gültekin ^[3] ; Muhammed Fatih Şimşekoğlu ^[3] ; Muhammet Demirbilek ^[1] ; Göktuğ Kalender ^[4] ; Birgi Ercili ^[2] ; Alper Okur ^[3] ; Çetin Demirdağ ^[3] ; Bülent Önal ^[3]
  1. [1] State Hospital

     State Hospital

     Reino Unido

     
  2. [2] Memorial Hospital

     Memorial Hospital

     City of York, Estados Unidos

     
  3. [3] Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, 34153 Istanbul, Turkey
  4. [4] Department of Urology, Istanbul Beykoz State Hospital, 34800 Istanbul, Turkey

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• Localización: Archivos españoles de urología, ISSN 0004-0614, Tomo 78, Nº. 10, 2025, págs. 1368-1376
• Idioma: inglés
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  • 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.