You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (PD16)1 Sep 2021PD16-10 2017 AUA GUIDELINES FOR LOCALIZED RENAL CANCER: COMPLIANCE AND PRACTICALITY IN THE REAL WORLD Rebecca Campbell, Jason Scovell, Nityam Rathi, Pedram Aram, Venkatesh Krishnamurthi, David Goldfarb, Mohamed Eltemamy, Christopher Weight, Alvin Wee, Georges-Pascal Haber, and Steven Campbell Rebecca CampbellRebecca Campbell More articles by this author , Jason ScovellJason Scovell More articles by this author , Nityam RathiNityam Rathi More articles by this author , Pedram AramPedram Aram More articles by this author , Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author , David GoldfarbDavid Goldfarb More articles by this author , Mohamed EltemamyMohamed Eltemamy More articles by this author , Christopher WeightChristopher Weight More articles by this author , Alvin WeeAlvin Wee More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , and Steven CampbellSteven Campbell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001998.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: AUA Guidelines for renal cancer (2017) recommend consideration for radical nephrectomy (RN) over partial (PN) whenever there is ↑ oncologic risk (OR); and RN should then be prioritize if 3 other criteria are all also met: 1) ↑ tumor complexity (TC); 2) no preexisting CKD/proteinuria, and 3) normal opposite kidney that will likely provide eGFR >45 even if RN is performed. Our objective was to assess compliance with the Guidelines and complexity of decision-making about RN/PN. METHODS: Retrospective review of consecutive RN/PN patients (n=100 of each) in 2019 in our hospital system. Preoperative imaging was reviewed and high TC was defined as RENAL≥9. Increased OR was defined as tumor >7 cm, or locally advanced or infiltrative features, or high risk pathology on biopsy, if obtained. Predicted GFR in each kidney was calculated using global eGFR, split renal function, and assumption of 25% compensation if RN performed, per previous publications. RESULTS: Nine patients underwent RN due to poorly functioning ipsilateral kidney. 106 patients fit into scenarios that are well-defined in the Guidelines. Of these, 25 patients met all 4 criteria for RN and all underwent RN (no imprudent PN). Potential noncompliance was observed in 11/106 (10.3%) cases, where patients underwent RN despite Guidelines favoring PN. The remaining 85 patients (45%) did not fit within situations where the Guidelines provide specific recommendations. In these patients, RN was often performed despite functional considerations that would favor PN due to overriding concerns about OR and/or TC (e.g. 28/29 patients with ↑OR/↑TC underwent RN despite preexisting CKD and/or suboptimal opposite kidney). Management of patients with ↓OR/↑TC was the most variable and appeared to be mostly dependent on surgeon preference. Surgeons accepted the challenge of PN despite ↑TC in 28/49 (57%) of such patients. CONCLUSIONS: Our data demonstrate generally good compliance with the AUA Guidelines, although overutilization of RN remains a concern. Furthermore, many patients do not fit well-defined Guidelines descriptors, confirming complexity of decision-making about RN/PN. Finally, renal mass in poorly functioning kidney is an indication for RN that is discussed in the Guidelines text but probably should be incorporated into the formal statements . Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e282-e282 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rebecca Campbell More articles by this author Jason Scovell More articles by this author Nityam Rathi More articles by this author Pedram Aram More articles by this author Venkatesh Krishnamurthi More articles by this author David Goldfarb More articles by this author Mohamed Eltemamy More articles by this author Christopher Weight More articles by this author Alvin Wee More articles by this author Georges-Pascal Haber More articles by this author Steven Campbell More articles by this author Expand All Advertisement Loading ...