PD02-11 COMPARISON OF PERIOPERATIVE OUTCOMES BASED ON SURGICAL APPROACH FOR RENAL MASSES > 10CM

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I (PD02)1 Apr 2020PD02-11 COMPARISON OF PERIOPERATIVE OUTCOMES BASED ON SURGICAL APPROACH FOR RENAL MASSES > 10CM Felix Chen*, Jenny Chang, Argyrios Ziogas, John Sfakianos, Ketan Badani, Edward Uchio, Hoda Anton-Culver, and Greg Gin Felix Chen*Felix Chen* More articles by this author , Jenny ChangJenny Chang More articles by this author , Argyrios ZiogasArgyrios Ziogas More articles by this author , John SfakianosJohn Sfakianos More articles by this author , Ketan BadaniKetan Badani More articles by this author , Edward UchioEdward Uchio More articles by this author , Hoda Anton-CulverHoda Anton-Culver More articles by this author , and Greg GinGreg Gin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000822.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Minimally invasive approaches for radical nephrectomy have surpassed open surgery. Robotic-assisted laparoscopic radical nephrectomy (RRN) is increasingly utilized as an alternative to laparoscopic radical nephrectomy (LRN) but there are concerns over costs and measurable benefit. In the setting of very large renal masses (>10 cm), comparison between techniques is limited and it is unclear whether a robotic approach confers any perioperative benefit over LRN or open radical nephrectomy (ORN). In this study, we compare perioperative outcomes for robotic-assisted, laparoscopic, and open radical nephrectomy for very large renal masses. METHODS: Using the National Cancer Database, we identified patients who underwent radical nephrectomy for kidney tumors >10 cm diagnosed from 2010-2015. We excluded patients with cT3b-4 disease. Patients were analyzed according to surgical approach: RRN versus LRN versus ORN. Using multivariate logistic and linear regression, perioperative outcomes, including conversion to open, length of stay, readmission rates, positive surgical margins, and 30 and 90-day mortality were compared among cohorts. 1:1 Propensity matching was also performed to compare cohorts. We also analyzed utilization trends of each approach over the study period. RESULTS: A total of 9288 patients met inclusion criteria (RRN = 842, LRN = 2326, ORN = 6120). On multivariate analysis, LRN had a higher rate of conversion to open compared to RRN (OR 1.48; 95% CI 1.10-1.98; p=0.0087). Compared to ORN, recipients of either RRN or LRN had similar rates of 30-day readmission, 30-day mortality, and 90-day mortality. Length of hospital stay was significantly shorter in RRN (-1.73 days ± 0.19; p<0.0001) and LRN (-1.40 days ± 0.12; p<0.0001) compared to ORN. Conversion to open from RRN or LRN added 1.3 additional days of inpatient stay. RRN and LRN were less likely to have positive surgical margin than ORN (RRN: OR 0.75; 95% CI 0.56-0.99; p=0.044, LRN: OR 0.64; 95% CI 0.52-0.78; p<0.0001). Over the study period, RRN use increased from 4.1% to 14.8%, LRN from 20.9% to 25.6%, while ORN use decreased from 75% to 59.6%. CONCLUSIONS: Minimally invasive approaches are increasingly utilized in very large renal masses. After adjusting for covariates, RRN has lower rates of conversion to open but produces comparable perioperative outcomes to pure laparoscopy. Minimally invasive approaches have shorter length of inpatient stay but otherwise report similar readmission and mortality rates compared to open radical nephrectomy. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e70-e71 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Felix Chen* More articles by this author Jenny Chang More articles by this author Argyrios Ziogas More articles by this author John Sfakianos More articles by this author Ketan Badani More articles by this author Edward Uchio More articles by this author Hoda Anton-Culver More articles by this author Greg Gin More articles by this author Expand All Advertisement PDF downloadLoading ...