Category: Clinical Oncology: Outcomes & Complications

MP23-6 - Comparative Analysis of Minimally Invasive Radical and Partial Nephrectomy for Clinical T2 Renal Mass: Analysis of the RObotic SUrgery for LArge renal mass (ROSULA) Group

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Utilization of partial nephrectomy (PN) for clinical T2 renal mass (cT2RM) is controversial. Minimally invasive surgery (MIS) is increasingly used in larger masses, though impact of MIS in cT2RM is unclear. We compared outcomes of MIS PN and radical nephrectomy (RN) in cT2RM.


Methods :

Retrospective international multicenter analysis of MIS PN and RN for cT2RM (T2N0M0) [RObotic SUrgery for LArge renal mass (ROSULA) Group]. Primary outcome was change in estimated glomerular filtration rate (Δ eGFR). Secondary outcomes included complication rates, de novo Chronic Kidney Disease (CKD, eGFR<60 60 mL/min/1.73m2) and eGFR<45, overall survival (OS) and progression free survival (PFS). Multivariable analysis (MVA) and Kaplan-Meier analysis (KMA) were carried out for survival and de novo eGFR<45.


Results : 847 patients (201 PN/633 RN, median follow up 20 months) were analyzed. RN had larger tumor size (9.2 vs. 8.5 cm, p<0.001) and RENAL score (9.5 vs. 9, p=0.001). Median ischemia time for PN was 22 minutes. No significant differences were noted for 30 day complications (PN 24% vs. RN 17.9%, p=0.1) or readmissions (p=0.1). PN had higher estimated blood loss (230 mL vs. 174 mL, p=0.034) and positive margin rate (7.8% vs. RN 3.6%, p=0.028). PN had lower ΔeGFR (9.2 vs 30, p<0.001) de novo CKD (14.7% vs. 55.6%, p<0.001) and de novo eGFR <45 (4.1% vs. 32.3%, p<0.001). MVA revealed that increasing ASA (American Society of Anesthesiologists) score (HR 5.83, p<0.001) was predictive for all cause mortality, but not type of surgery (p=0.29). Increasing age (HR 1.07, p <0.001) and RN (HR 13.5, p <0.001) were independent predictors for de novo eGFR<45. KMA showed 87% and 82% 5-year OS for patients who underwent PN and RN, respectively (p =0.189) No significant differences were noted for 5 year PFS (PN 82.5% vs. RN 70%, p


Conclusions :

MIS PN for select cT2RM provides renal functional benefit while not compromising oncologic and outcomes and not having greater morbidity. Consideration may be given to PN in cT2RM when technically feasible and indicated.

Ithaar Derweesh

Professor of Urology and Radiology Program Director, Urologic Oncology Fellowship
Department of Urology, University of California San Diego School of Medicine
San Diego, California

Ahmet Bindayi

University of California San Diego
San Diego, California

Giuseppe Simone

Consultant
“Regina Elena” National Cancer Institute, Dept. of Urology
Roma, Lazio, Italy

Stephen Ryan

Urologic Oncology Fellow
University of California San Diego
San Diego, California

Medical School: East Carolina University
Residency: Maine Medical
Fellowship: Uro/Onc UCSD

Andrea Minervini

Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
Florence, Toscana, Italy

Daniel D. Eun

Professor
Temple University
Philadelphia, Pennsylvania

James Porter

Medical Director for Robotic Surgery
Swedish Medical Center
Seattle, Washington

Ryan Nasseri

University of California San Diego
Poway, California

Koon Ho Rha

Professor
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
Seodaemun-gu, Seoul-t'ukpyolsi, Republic of Korea

Robert Uzzo

Professor and Chief of Surgical Oncology
Fox Chase Cancer Center
Philadelphia, Pennsylvania

Francesco Berardinelli

Urology Unit, Annunziata Hospital, Chieti, Italy
Chieti, Abruzzi, Italy

Wesley White

Division of Urologic Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
Knoxville, Tennessee

Ken Jacobsohn

Department of Urology, Medical College Wisconsin, Milwaukee, WI, USA
Milwaukee, Wisconsin

Francesco Montorsi

Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
Milan, Lombardia, Italy