MP57-15 IMPERATIVE VERSUS ELECTIVE PURELY OFF-CLAMP MINIMALLY-INVASIVE PARTIAL NEPHRECTOMY: RESULTS OF A SINGLE-CENTRE EXPERIENCE

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (MP57)1 Apr 2020MP57-15 IMPERATIVE VERSUS ELECTIVE PURELY OFF-CLAMP MINIMALLY-INVASIVE PARTIAL NEPHRECTOMY: RESULTS OF A SINGLE-CENTRE EXPERIENCE Rocco Simone Flammia*, Umberto Anceschi, Aldo Brassetti, Gabriele Tuderti, Mariaconsiglia Ferriero, Riccardo Mastroianni, Salvatore Guaglianone, Manuela Costantini, Alfredo Bove, Michele Gallucci, and Giuseppe Simone Rocco Simone Flammia*Rocco Simone Flammia* More articles by this author , Umberto AnceschiUmberto Anceschi More articles by this author , Aldo BrassettiAldo Brassetti More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Mariaconsiglia FerrieroMariaconsiglia Ferriero More articles by this author , Riccardo MastroianniRiccardo Mastroianni More articles by this author , Salvatore GuaglianoneSalvatore Guaglianone More articles by this author , Manuela CostantiniManuela Costantini More articles by this author , Alfredo BoveAlfredo Bove More articles by this author , Michele GallucciMichele Gallucci More articles by this author , and Giuseppe SimoneGiuseppe Simone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000926.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the imperative setting, PN is usually associated to worse functional outcomes and a greater risk of complications. The aim of this study is to compare perioperative and functional outcomes between patients who underwent minimally-invasive purely-off clamp partial nephrectomy (ocMIPN) for an imperative (I) or elective (E) indication at a single high-volume centre. METHODS: From July 2004 to October 2019, we analyzed perioperative, oncologic and functional outcomes of 701 patients who underwent ocMIPN, 242 with I and 459 with E indications. Data were retrieved from our prospectively-mantained PN dataset. E and I cohorts were matched for baseline, perioperative, oncologic and functional data. For categorical and continuous variables were reported as IQRs or frequencies and compared with χ2 – and Student t tests. Kaplan-Meier analysis was performed to compare RFS and OS between groups. RESULTS: Out of 242 I-ocMIPN patients, 76 were solitary kidneys, 132 had impaired preoperative renal function, 5 had horseshoes kidneys and 29 had bilateral renal tumors. I-ocMIPN patients had significantly lower baseline eGFR (p<0.001), and a trend towards a significantly higher ASA score (p=0.06) and lower tumor size (p=0.08). All other baseline data were comparable (all p>0.19, Table 1). Positive surgical margins rate (p=0.59), conversion to open surgery or radical nephrectomy (p=1), complication rates according to Clavien–Dindo (p= 0.472) were comparable between groups, while I-ocMIPN patients had significantly higher length of hospital stay (4.7 vs 4, p<0.001) and eGFR at discharge decrease (-13% vs -2.64%, p< 0.001). At a median follow-up of 28 months (IQR 7-56), last eGFR (79.6 vs 56.1, p <0.0001), and newly onset CKD-3b (1.9% vs 15.6%, p< 0.001) and CKD-4,5 stages (1.1 vs 6.7%, p< 0.001) were significantly higher in I-ocMIPN cohorts. (Tab.1) OS and RFS were comparable between groups (p=0.79 and 0.71, respectively). CONCLUSIONS: Although associated to a longer hospital stay, and to an increased rate of significant renal function deterioration, the oncologic outcomes of I-ocMIPN are comparable to those expected in the elective setting. These aspects should be considered during patient counselling when offering nephron sparing surgery in imperative setting. Source of Funding: no © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e866-e867 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rocco Simone Flammia* More articles by this author Umberto Anceschi More articles by this author Aldo Brassetti More articles by this author Gabriele Tuderti More articles by this author Mariaconsiglia Ferriero More articles by this author Riccardo Mastroianni More articles by this author Salvatore Guaglianone More articles by this author Manuela Costantini More articles by this author Alfredo Bove More articles by this author Michele Gallucci More articles by this author Giuseppe Simone More articles by this author Expand All Advertisement PDF downloadLoading ...