1448 MINIMALLY INVASIVE TREATMENT OF CT1 RENAL TUMORS: 10-YR PARADIGM SHIFT AT A TERTIARY REFERRAL CENTRE

Abstract

INTRODUCTION AND OBJECTIVES: To present the paradigm shift in the management of cT1 renal tumors, from open radical nephrectomy to minimally invasive techniques of nephron-sparing surgery in a 10-yr experience at a tertiary referral centre. METHODS: Between September 2001 and December 2011, 719 cT1N0M0 renal tumors were diagnosed at our institution. We reported the evolving management of cT1 renal masses from open to laparoscopic radical nephrectomies (RN) and from open to laparoscopic and robotic partial nephrectomies (PN) along ten years. We compared the drift of RN versus PN for cT1, cT1a and cT1b tumors, respectively and the trend of Laparoscopic PN (LPN) vs open PN (OPN) for cT1a and cT1b, respectively. RESULTS: Overall, 50 (6.9%), 111 (15.5%), 181 (25.2%), 343 (47.7%), 34 (4.7%) patients underwent ORN, OPN, LRN, LPN and Robotic PN, respectively. The rate of PN for cT1 tumors increased over time and passed RN in 2007 (Fig1). The shift from radical to partial nephrectomy became evident in 2002 for cT1a and 2010 for cT1b tumors, respectively (Fig. 2a). The shift from OPN to LPN became clear in 2005 and 2010 for cT1a and cT1b tumors, respectively.(Fig. 2b) CONCLUSIONS: Practice at our centre reflects a shifting paradigm towards preferential use of nephron sparing surgery for the treatment of cT1 renal masses; minimally invasive PN early became a gold standard for cT1a tumors. Later, given laparoscopic expertise and appropriate patient selection, indications to robotic and LPN were expanded and became predominant also for renal masses 4 cm. Source of Funding: None