There is a lack of large-scale studies comparing the functional results of the open, laparoscopic and robotic nephron sparing surgery techniques in the modern literature. The aim of our study was to conduct a comparative analysis of the three partial nephrectomy (PN) techniques according to trifecta and pentafecta criteria.

The prospective study included 600 patients with renal cell carcinoma (RCC) from 2018 to 2022. PN was performed by open (200 patients), laparoscopic (200 patients) and robotic (200 patients) techniques. Outcomes were assessed by trifecta (negative surgical margin; warm ischemia time ≤25 minutes or without ischemia; no ≥III grade postoperative complications according to the Clavien–Dindo classification within 3 months after surgery and pentafecta (trifecta plus ≥90% estimated glomerular filtration rate preservation and no chronic kidney disease stage increase 12 months after surgery).

The trifecta was achieved by open, laparoscopic and robotic techniques in 82%, 89% and 84%, respectively. According to this criteria, no significant differences were found between the methods (p ˃0.05). Pentafecta was achieved after open, laparoscopic and robotic techniques in 53%, 64% and 66%, respectively. There was significant advantage of the two minimally invasive techniques versus the open technique (p <0.05)(Table 1). Significant difference was found in functional results depend on RENAL score as shown in Table 2. For RENAL 4–6 tumors the best rates were shown by laparoscopic and robotic PN.The pentafecta of robotic PN for moderately complex tumors (RENAL 7–9) was significantly better than in open surgery. For the most complex tumors the best results were achieved by open and robotic techniques.

Immediate perioperative results were the same between the all techniques. While better functional results as shown by pentafecta were achieved by minimally invasive surgeries. In complex tumors there is still a place for open surgery on par with robot-assisted PN.