MP66-07 TRENDS AND MORBIDITY FOR MINIMALLY INVASIVE VERSUS OPEN CYTOREDUCTIVE NEPHRECTOMY IN THE MANAGEMENT OF METASTATIC RENAL CELL CARCINOMA

Abstract

You have accessJournal of UrologyKidney Cancer: Advanced (including Drug Therapy) II1 Apr 2018MP66-07 TRENDS AND MORBIDITY FOR MINIMALLY INVASIVE VERSUS OPEN CYTOREDUCTIVE NEPHRECTOMY IN THE MANAGEMENT OF METASTATIC RENAL CELL CARCINOMA Dimitar Zlatev, Manuel Ozambela, Ye Wang, Matthew Mossanen, Daniel Pucheril, Matthew D. Ingham, Philip V. Barbosa, Benjamin I. Chung, and Steven L. Chang Dimitar ZlatevDimitar Zlatev More articles by this author , Manuel OzambelaManuel Ozambela More articles by this author , Ye WangYe Wang More articles by this author , Matthew MossanenMatthew Mossanen More articles by this author , Daniel PucherilDaniel Pucheril More articles by this author , Matthew D. InghamMatthew D. Ingham More articles by this author , Philip V. BarbosaPhilip V. Barbosa More articles by this author , Benjamin I. ChungBenjamin I. Chung More articles by this author , and Steven L. ChangSteven L. Chang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1879AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cytoreductive nephrectomy (CN) prior to systemic therapy for metastatic renal cell carcinoma (RCC) is recommended in patients with a surgically resectable primary tumor. Traditionally performed as open surgery, the advent of laparoscopic and robotic surgery provides a minimally invasive alternative to CN with a potential for accelerated recovery and earlier initiation of systemic therapy. We sought to compare the trends and morbidity of laparoscopic, robotic, and open CN for patients with metastatic RCC. METHODS Using the Premier Hospital Database (Premier, Inc., Charlotte, NC), we identified 24,145 patients who underwent elective radical nephrectomy for metastatic RCC in the United States between 2003 and 2015. Comparative analysis between laparoscopic, robotic, and open CN was performed with propensity weighting on rates of 90-day complications, blood transfusion, intensive care unit (ICU) admission, prolonged length of stay (LOS), discharge destination, 90-day readmission, operative time, and direct hospital costs. RESULTS Over the course of the study period, the rates of open CN decreased from 76.7% to 66.4%, laparoscopic CN decreased from 22.3% to 11.4%, and robotic CN increased from 0.6% to 22.1%. Compared to open CN, the laparoscopic approach was associated with a 30% decreased odds of 90-day major complications (OR 0.70, 95% CI 0.50 - 0.97, p<0.05). Compared to open CN, both laparoscopic and robotic approaches were associated with significantly decreased odds of blood transfusion (OR 0.46 and 0.38, respectively), ICU admission (OR 0.57 and 0.48, respectively), and LOS (OR 0.50 and 0.35, respectively). Direct costs were lowest for laparoscopic CN. CONCLUSIONS Compared to open CN, minimally invasive CN is associated with relatively lower amounts of surgical morbidity. Laparoscopic CN is additionally associated with decreased direct costs compared to open CN. When technically feasible, the utilization of minimally invasive CN, especially laparoscopic, may serve to reduce the burden of metastatic RCC on the health care system by accelerating recovery, facilitating earlier initiation of systemic therapy, and decreasing overall costs of care. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e870 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Dimitar Zlatev More articles by this author Manuel Ozambela More articles by this author Ye Wang More articles by this author Matthew Mossanen More articles by this author Daniel Pucheril More articles by this author Matthew D. Ingham More articles by this author Philip V. Barbosa More articles by this author Benjamin I. Chung More articles by this author Steven L. Chang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...