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|Title:||MP75-16: Outcomes of robot-assisted partial nephrectomy in patients with complex renal tumors and pre-existing chronic kidney disease: A multi-institutional analysis.|
|Epworth Authors:||Moon, Daniel|
|Other Authors:||Dalela, Deepansh|
Robot-Assisted Partial Nephrectomy
Chronic Kidney Disease
Vattikuti Collective Quality Initiative
Robotic Surgery, Epworth HealthCare, Victoria, Australia
UroRenal, Vascular Clinical Institute, Epworth HealthCare, Victoria, Australia
Cancer Services Clinical Institute, Epworth HealthCare, Victoria, Australia
|Citation:||The Journal of Urology; April 2016 vol. 195, Issue 4, Supplement, Page e985|
|Conference:||The American Urological Association Annual Meeting, 06 May 2016 - 10 May 2016.|
|Conference Location:||San Diego Convention Center, 111 W. Harbor Drive, San Diego, CA 92101.|
|Abstract:||INTRODUCTION AND OBJECTIVES: Partial nephrectomy can help preserve renal function, but may be more challenging in patients with complex tumors. We compare outcomes of robot-assisted partial nephrectomy (RAPN) for complex tumors in patients with and without pre-existing chronic kidney disease (CKD). METHODS: Using the Vattikuti Collective Quality Initiative (VCQI) database (representing patients and surgeons from 11 centers across 4 continents), we identified 250 patients undergoing RAPN for complex tumors (identified by RENAL or PADUA score of >10) between 2008-2013. Peri-operative (estimated blood loss [EBL], warm ischemia time [WIT], complications and positive surgical margins [PSM]) and functional outcomes (estimated glomerular filtration rate [eGFR] at 12-month follow-up) were assessed and stratified by preoperative CKD (CKD stage 3 or greater; n=33, 13.2%) vs. no significant CKD (eGFR >60 ml/min/1.73 m2; n=217, 86.8%). RESULTS: Overall, patients had a median (interquartile range) body mass index of 25.7 (23.3-28.9) kg/m2 and pre-operative eGFR of 83 (70-98) ml/min/1.73 m2 respectively. 48.4% tumors were >4 cm radius and 29.6% entirely endophytic. 95 (38%) tumors were posterior, 118 (47.2%) mid-polar and 67.2% had renal sinus involvement on preoperative imaging. Patients with CKD were older (median age 62 vs. 54; p=0.001), had higher median age-adjusted Charlson comorbidity score (5.5 vs. 2; p<0.001) and significantly larger tumors (median 4.7 vs. 4 cm; p=0.036) than patients without CKD. There were no significant differences in other tumor characteristics. Perioperatively, there were no significant differences in median WIT (24.5 vs. 22.5 min; p=0.5), operative (OR) time (175 vs. 180 min; p=0.2) and EBL (200 vs. 200 ml; p=0.9) between patients with vs. without CKD. A total of 26 patients overall experienced postoperative complications, of which 9 (3 in CKD group and 6 in non-CKD; p=0.09) were Clavien Grade 3 or higher. PSM were comparable: 9.1% in CKD vs. 6.0% in non-CKD group (p=0.2). Patients with preoperative CKD had a greater percent decrease in eGFR at median 12-month follow up (4.06% vs. 0.3%; p=0.05), but it did not translate into significantly higher incidence of new-onset CKD >=Stage 3. CONCLUSIONS: Despite the surgical challenges, RAPN for patients with complex renal tumors is safe and feasible, even for patients with CKD. Perioperative and functional outcomes 1 year after surgery appear acceptable, despite heterogeneity in surgical techniques, experience and patient population across multiple centers.|
|Affiliated Organisations:||Department of Urology, Henry Ford Hospital, Detroit, Michigan, United States.|
Cancer Prognostic and Health Outcomes Unit, Université de Montréal, Montréal, Quebec, Canada.
Robotic Urologic Surgery, Dublin Methodist Hopsital, Ohio.
Urology and Renal Transplantation, Fortis Escorts Institute of Kidney and Urology, New Delhi, India.
Urology Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
School of Medicine, King's College London, London, United Kingdom.
Department of Surgery, Oncology and Gastroenterology DISCOG, University of Padova, Padua, Italy.
Department of Urology, OLV Ziekenhuis Aalst, Belgium.
|Type of Clinical Study or Trial:||Comparative Study|
|Appears in Collections:||Cancer Services|
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