Clinical Oncology: Outcomes & Complications

Moderated Poster Session

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

Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 253

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

Presentation(s):

    Send Email for Ithaar Derweesh

    Ahmet Bindayi

    University of California San Diego

    Presentation(s):

      Send Email for Ahmet Bindayi

      Giuseppe Simone

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

      Presentation(s):

        Send Email for Giuseppe Simone

        Stephen Ryan

        Urologic Oncology Fellow
        University of California San Diego

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

        Presentation(s):

          Send Email for Stephen Ryan

          Andrea Minervini

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

          Presentation(s):

            Send Email for Andrea Minervini

            Daniel D. Eun

            Professor
            Temple University

            Presentation(s):

              Send Email for Daniel Eun

              James Porter

              Medical Director for Robotic Surgery
              Swedish Medical Center

              Presentation(s):

                Send Email for James Porter

                Ryan Nasseri

                University of California San Diego

                Presentation(s):

                  Send Email for Ryan Nasseri

                  Koon Ho Rha

                  Professor
                  Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea

                  Dr. Koon Ho Rha is Professor of Urology and Robotic and Minimally Invasive Surgery Center. He received both his premedicine education magna cum laude and his M.D. degree from the Yonsei University, Seoul. He underwent fellowship training in minimally invasive and laparoscopic surgery at the Johns Hopkins Medical Institution as Engineering and Urology endowed fellow, and served as visiting Assistant Professor in Urology at the Johns Hopkins University School of Medicine. During his stay, he also completed “Business in Medicine” a 1-year MBA program at the School of Business Administration and Education.
                  At Johns Hopkins, he continued his interests in the field of minimally invasive surgery/laparoscopy, and conducted further scientific studies with Dr. Louis R. Kavoussi, the leading pioneer on laparoscopic and robotic surgery. Dr. Rha set up the robotic surgery program at Yonsei University in 2005 which now became the most successful robotic program in the world with more than 21,000 cases. During last 10 years, Dr. Rha has performed the most robotic urological cases in Asia with more than 2800 cases of robotic cases including some 2500 cases of robotic prostatectomies. With cumulative experiences, Dr. Rha’s team developed world’s first robotic approaches of nephroureterectomies and single-incision partial nephrectomies. He has given more than 500 lectures on robotic surgery. He also performed live surgery or proctored more than 60 occasions, including US, France, Italy, Czech Republic, China, Japan, Taiwan, Singapore, Hong Kong, Saudi Arabia, Thailand and Malaysia. With interest in developing surgical robotic platform and devices, Dr. Rha lead the development Korean surgical (Revo-I, MeereCompany) since 2007 and successfully finished first human trial on robotic prostatectomy in 2017.

                  Presentation(s):

                    Send Email for Koon Ho Rha

                    Robert Uzzo

                    Professor and Chief of Surgical Oncology
                    Fox Chase Cancer Center

                    Presentation(s):

                      Send Email for Robert Uzzo

                      Francesco Berardinelli

                      Urology Unit, Annunziata Hospital, Chieti, Italy

                      Presentation(s):

                        Send Email for Francesco Berardinelli

                        Wesley White

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

                        Presentation(s):

                          Send Email for Wesley White

                          Ken Jacobsohn

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

                          Presentation(s):

                            Send Email for Ken Jacobsohn

                            Francesco Montorsi

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

                            Presentation(s):

                              Send Email for Francesco Montorsi


                              Assets

                              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



                              Attendees who have favorited this

                              Please enter your access key

                              The asset you are trying to access is locked. Please enter your access key to unlock.

                              Send Email for 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