{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T17:06:36Z","timestamp":1793207196642,"version":"4.5.0"},"reference-count":30,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J of Urology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Robot\u2010assisted laparoscopic partial nephrectomy (RAPN) for highly complex renal tumors can be challenging. However, determinants of oncological and functional outcomes after RAPN in this high\u2010risk population remain poorly characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively evaluated the clinical data of 396 consecutive patients who underwent RAPN for cT1N0M0 renal tumors of high complexity, defined as a RENAL nephrectomy score\u2009\u2265\u200910. Factors associated with trifecta (negative surgical margin, warm ischemic time\u2009\u2264\u200925\u2009min, and no surgical complications) and pentafecta achievement (\u2265\u200990% estimated glomerular filtration rate preservation and no chronic kidney disease stage upgrade at 1\u2009year postoperatively, along with trifecta achievement) were investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Trifecta was achieved in 201 patients (51%). Multivariable analysis showed that right\u2010side tumors (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0217), non\u2010hilar tumors (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0056), shorter operating times (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), and unexposed urinary systems (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0022) were independent factors for trifecta achievement. Among 334 patients with eligible data for pentafecta evaluation, 104 (31%) achieved pentafecta. After covariate adjustment, non\u2010hilar tumors (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0449), shorter operating times (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0003), and unexposed urinary systems (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0004) were independent factors for pentafecta achievement.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Factors associated with trifecta and pentafecta achievement after RAPN were identified for highly complex renal tumors. These perioperative factors may be utilized for postoperative outcome prediction after RAPN in this challenging population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/iju.70670","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:50:41Z","timestamp":1791874241000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Factors Associated With Trifecta and Pentafecta Achievement in Robot\u2010Assisted Laparoscopic Partial Nephrectomy for Highly Complex Renal Tumors"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5146-656X","authenticated-orcid":false,"given":"Hiroki","family":"Ishihara","sequence":"first","affiliation":[{"name":"Department of Urology Tokyo Women's Medical University  Shinjuku\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of Urology Tokyo Women's Medical University Adachi Medical Center  Adachi\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1407-2588","authenticated-orcid":false,"given":"Yuki","family":"Kobari","sequence":"additional","affiliation":[{"name":"Department of Urology Tokyo Women's Medical University  Shinjuku\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3009-0146","authenticated-orcid":false,"given":"Hironori","family":"Fukuda","sequence":"additional","affiliation":[{"name":"Department of Urology Tokyo Women's Medical University  Shinjuku\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3834-0153","authenticated-orcid":false,"given":"Kazuhiko","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Urology Tokyo Women's Medical University  Shinjuku\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2228-4086","authenticated-orcid":false,"given":"Tsunenori","family":"Kondo","sequence":"additional","affiliation":[{"name":"Department of Urology Tokyo Women's Medical University Adachi Medical Center  Adachi\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1775-0943","authenticated-orcid":false,"given":"Toshio","family":"Takagi","sequence":"additional","affiliation":[{"name":"Department of Urology Tokyo Women's Medical University  Shinjuku\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2012.10.024"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1089\/end.2016.0351"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.14250"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urolonc.2018.06.012"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2025.04.005"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1089\/end.2020.0151"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2012.03.012"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0094878"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2014.12.028"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2012.09.042"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.12933"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/ases.12767"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/bju.13501"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0151738"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10147-019-01565-0"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2009.05.035"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2009.07.040"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2018.08.037"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11701-024-02050-1"},{"issue":"5","key":"e_1_2_10_21_1","first-page":"518","article-title":"Proposed Classification of Complications of Surgery With Examples of Utility in Cholecystectomy","volume":"111","author":"Clavien P. 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