MP75-12 MULTICENTER COMPARISON OF ROBOTIC AND OPEN PARTIAL NEPHRECTOMY FOR QUALITY MEASURES CONTROLLING FOR TUMOR COMPLEXITY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V1 Apr 2016MP75-12 MULTICENTER COMPARISON OF ROBOTIC AND OPEN PARTIAL NEPHRECTOMY FOR QUALITY MEASURES CONTROLLING FOR TUMOR COMPLEXITY Zachary Hamilton, Sean Berquist, Abd-el Rahman Hassan, Catherine Defour, Alp Tuna Beksac, Fang Wan, Maria Marquine, Brian Lane, Sean Stroup, and Ithaar Derweesh Zachary HamiltonZachary Hamilton More articles by this author , Sean BerquistSean Berquist More articles by this author , Abd-el Rahman HassanAbd-el Rahman Hassan More articles by this author , Catherine DefourCatherine Defour More articles by this author , Alp Tuna BeksacAlp Tuna Beksac More articles by this author , Fang WanFang Wan More articles by this author , Maria MarquineMaria Marquine More articles by this author , Brian LaneBrian Lane More articles by this author , Sean StroupSean Stroup More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1730AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy (PN) is now the standard therapy for small renal masses. Robotic partial nephrectomy (RPN) is being rapidly adopted in this setting. Nonetheless, concerns persist about the risks of renal functional recovery in more complex masses, given the risk of prolonged warm ischemic time in RPN. We compared RPN and open PN (OPN) utilizing a composite outcome of surgical quality which emphasized renal functional recovery in addition to technical outcomes, while controlling for tumor complexity. METHODS Multicenter retrospective analysis of OPN and RPN in patients with small renal masses performed from 2000-2015. Demographics, tumor characteristics, perioperative outcomes were reviewed. Primary outcome was Trifecta, consisting of negative surgical margin, no perioperative complications within 30 days of surgery, and return of glomerular filtration rate (GFR) to ≥80% of baseline. Secondary outcome included ΔGFR at last follow up. Patients were stratified by RENAL nephrometry scores in three complexity groups: low (4-6), intermediate (7-9), and high (10-12), and comparisons between RPN and OPN were carried out within these groups. Multi-variable analysis (MVA) was performed to identify risk factors associated with achievement of Trifecta. RESULTS 798 patients were analyzed (mean age 62.9 ± 13.78 years, tumor size 3.3 ± 2.3 cm, 54.8% RPN/44.2% OPN; 38.4% were simple (71.7% RPN/28.3% OPN), 44.5% were intermediate (63.6% RPN/36.4% OPN), and 17.1% were high complexity (37.6% RPN/62.4% OPN). ΔeGFR for RPN vs. OPN for simple, intermediate, and high complexity RENAL scores was 3.01 vs. -0.13 (p=0.3), 1.22 vs. -3.95 (p=0.105), and -4.20 vs. -0.12 (p=0.543), respectively. There was no difference in trifecta rate between RPN and OPN for low complexity (53.4% vs. 43.2%, p=0.267) or high complexity (39.3% vs. 51.0%, p=0.319) groups. For intermediate complexity masses, RPN had improved rates of trifecta (61.3% vs. 42.0%, OR 2.19, p=0.01). After adjusting for significant covariates on MVA (including age, sex, hypertension, diabetes, coronary artery disease, and estimated blood loss) RPN was associated with higher rate of trifecta (OR 1.88, p=0.002). CONCLUSIONS When controlling for renal tumor complexity using RENAL score, RPN was an independent factor associated with improved odds of achieving Trifecta. Unless surgically contraindicated, RPN may be viewed as the primary surgical option for PN regardless of tumor complexity. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e983 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Zachary Hamilton More articles by this author Sean Berquist More articles by this author Abd-el Rahman Hassan More articles by this author Catherine Defour More articles by this author Alp Tuna Beksac More articles by this author Fang Wan More articles by this author Maria Marquine More articles by this author Brian Lane More articles by this author Sean Stroup More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...