MP75-15 OPTIMAL OUTCOME AND TRIFECTA OF ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR T1B RENAL MASSES

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V1 Apr 2016MP75-15 OPTIMAL OUTCOME AND TRIFECTA OF ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR T1B RENAL MASSES Dae Keun Kim, Young Eun Yoon, Ibrahim Alabdulaali, Atalla Alatawi, Abulhasan Sheikh, Ali Abdel Raheem, Kyo Chul Goo, Woong Kyu Han, Byung Ha Chung, and Koon Ho Rha Dae Keun KimDae Keun Kim More articles by this author , Young Eun YoonYoung Eun Yoon More articles by this author , Ibrahim AlabdulaaliIbrahim Alabdulaali More articles by this author , Atalla AlatawiAtalla Alatawi More articles by this author , Abulhasan SheikhAbulhasan Sheikh More articles by this author , Ali Abdel RaheemAli Abdel Raheem More articles by this author , Kyo Chul GooKyo Chul Goo More articles by this author , Woong Kyu HanWoong Kyu Han More articles by this author , Byung Ha ChungByung Ha Chung More articles by this author , and Koon Ho RhaKoon Ho Rha More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1733AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The new concept of optimal outcome the pentafecta of oncology, complications and functional outcome has been proposed as a measure of effectiveness of robotic partial nephrectomy (RPN) in the treatment of small renal masses. The utility of optimal outcome for the assessment of larger renal tumors has not been studied. This study was to assess the rate of optimal outcome and trifecta in cases of RPN for T1b renal tumors, in a large tertiary center. METHODS We retrospectively reviewed the medical records of 277 cases of RPN performed from 2007 to 2015. We limited our study to RPN for clinically T1b renal masses (> 4cm and less than or equal 7 cm). Tumor complexity was investigated according to R.E.N.A.L nephrometry score. The optimal outcome was defined as achievement of Trifecta (negative surgical margin, no perioperative complications and warm ischemia time of less than or equal 25 minutes) with addition of over 90% estimated GFR preservation and no chronic kidney disease stage upgrading (postoperative 6-12 months). Logistic regression analysis for factors predicting optimal outcome (age, body mass index, operation time, EBL, tumor size, R.E.N.A.L nephrometry score, experience with RPN, preoperative GFR) was performed. RESULTS Total of 60 patients met our inclusion criteria. The median age of the cohort was 49.5 yrs. (IQR 39.8-62) and the median R.E.N.A.L. nephrometry score was 9 (IQR 7-9). The median warm ischemia time was 26.5 min (IQR 21-31.75) positive margin rate of 5%, and overall complication rate of 15%. The rate of achievement of optimal outcome was 26.7%, and trifecta rate was 43.3%. On multivariable analysis, tumor size (HR 0.42 95% CI (0.18-0.93 p=0.04), operation time (HR 0.98 95% CI(0.97-0.99) p=0.011) were predictors of achieving trifecta, and R.E.N.A.L nephrometry score (HR 0.80; 95% CI (0.67-0.97) p=0.03) was predictor of achieving optimal outcome. CONCLUSIONS Renal nephrometry score was the predictor of achieving optimal outcome for T1b tumors in our cohort. Addition of over 90 % estimated GFR preservation and no chronic kidney disease stage upgrading incorporate the long-term functional outcome of RPN, providing us with oncological and also functional surrogate for surgical quality. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e984-e985 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Dae Keun Kim More articles by this author Young Eun Yoon More articles by this author Ibrahim Alabdulaali More articles by this author Atalla Alatawi More articles by this author Abulhasan Sheikh More articles by this author Ali Abdel Raheem More articles by this author Kyo Chul Goo More articles by this author Woong Kyu Han More articles by this author Byung Ha Chung More articles by this author Koon Ho Rha More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...