PD11-07 NATURAL HISTORY OF RADIOLOGIC TROCAR SITE HERNIA FOLLOWING ROBOTIC NEPHRECTOMY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD11)1 Apr 2020PD11-07 NATURAL HISTORY OF RADIOLOGIC TROCAR SITE HERNIA FOLLOWING ROBOTIC NEPHRECTOMY Alireza Ghoreifi*, Gilbert Whang, Khoa Tran, Tapas Tejura, Simin Hajian, Benjamin Liu, Jie Cai, Xiaomeng Lei, Mohammad Aslzare, Madeleine Burg, Steven Cen, Mihir Desai, Monish Aron, Inderbir Gill, Vinay Duddalwar, and Hooman Djaladat Alireza Ghoreifi*Alireza Ghoreifi* More articles by this author , Gilbert WhangGilbert Whang More articles by this author , Khoa TranKhoa Tran More articles by this author , Tapas TejuraTapas Tejura More articles by this author , Simin HajianSimin Hajian More articles by this author , Benjamin LiuBenjamin Liu More articles by this author , Jie CaiJie Cai More articles by this author , Xiaomeng LeiXiaomeng Lei More articles by this author , Mohammad AslzareMohammad Aslzare More articles by this author , Madeleine BurgMadeleine Burg More articles by this author , Steven CenSteven Cen More articles by this author , Mihir DesaiMihir Desai More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir GillInderbir Gill More articles by this author , Vinay DuddalwarVinay Duddalwar More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000845.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is no available data on the natural history of radiologic trocar site hernia (TSH) especially in urologic surgeries. The aim of this study is to evaluate the incidence and natural history of radiologic TSH in patients who underwent robotic partial or radical nephrectomy. METHODS: We retrospectively reviewed the records of patients who underwent robotic partial or radical nephrectomy for kidney tumor at USC between January 2011 and April 2017. All pre and postoperative imagings were re-reviewed for detection of TSH per Tonouchi classification by three uro-radiologists with high Intra Class Correlation (ICC=0.94, 95% CI 0.86-0.97). Patients who developed hernia were followed up and classified into stable or progressive group (Figure 1). Progressive TSH was defines as either significant size change, upgrading per Tonouchi classification, or becoming symptomatic. RESULTS: A total of 247 patients (169 partial and 78 radical nephrectomy) were included in the study. Pathologic stage was T1 (74.5%), T2 (5.7%), T3 (19.4%), and T4 (0.4%). The incidence of radiologic TSH was 27.53%, graded as early-onset (35.3%), late-onset (51.5%) and bowel/fat-containing (13.2%). The locations were midline (58.8%: including ≥ 10 mm assistant port), anterolateral (36.8%), and posterior (4.4.%). The incidence of TSH was not different between partial and radical nephrectomy cases (26.6% and 29.5%, p=0.43). Median time to radiologic TSH was 1.7 years (IQR 0.84-2.52). During the follow up of 68 patients who developed hernia, 33 (48.5%) had progressive TSH. Median time to progression was 1.5 years (IQR 0.68-2.01). On multivariable analysis, adjuvant therapy was an independent predictor for radiologic hernia development (HR 3.23, 95% CI 1.44-7.27, p=0.005). Pathologic T stage ≥ 2 and history of open abdominal surgery were also significantly associated with hernia progression (HR 3.93, 95% CI 1.74-8.89, p=0.001 and HR 3.47, 95% CI 1.53-7.93, p=0.003, respectively). CONCLUSIONS: Radiologic TSH following robotic partial or radical nephrectomy is common. Progression rate is as high as 50% with median time to progression of 1.5 years. Adjuvant therapy is an independent predictor for TSH development, while higher stage and history of open abdominal surgery are associated with TSH progression Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e256-e256 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alireza Ghoreifi* More articles by this author Gilbert Whang More articles by this author Khoa Tran More articles by this author Tapas Tejura More articles by this author Simin Hajian More articles by this author Benjamin Liu More articles by this author Jie Cai More articles by this author Xiaomeng Lei More articles by this author Mohammad Aslzare More articles by this author Madeleine Burg More articles by this author Steven Cen More articles by this author Mihir Desai More articles by this author Monish Aron More articles by this author Inderbir Gill More articles by this author Vinay Duddalwar More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement PDF downloadLoading ...