Minimally Invasive Partial Nephrectomy Research Articles

Trends and Costs of Minimally Invasive Surgery for Kidney Cancer in the US: A Population-based Study

ObjectiveTo analyze temporal trends and costs associated with the use of minimally invasive surgery (MIS) for kidney cancer in the US over the past decade. To examine the impact of social determinants of health (SDOH) on perioperative outcomes. MethodsThe PearlDiver Mariner, a national database of insurance billing records, was queried for this retrospective observational cohort analysis. The MIS population was identified and stratified according to treatment modality, using International Classification of Diseases (ICD) and current procedural terminology (CPT) codes. SDOH were assessed using ICD codes. Negative binomial regression was used to evaluate the overall number of renal MIS and Cochran-Armitage tests to compare the utilization of different treatment modalities, over the study period. Multivariable logistic regression analysis identified predictors of perioperative complications. ResultsA total of 80,821 MIS for kidney cancer were included. Minimally invasive partial nephrectomy (MIPN) adoption as a fraction of total MIS increased significantly (slope of regression line, reg. = 0.026, p<.001). Minimally invasive radical nephrectomy (MIRN) ($26,9k±40,9k) and renal ablation (RA) ($18,9k±31,6k) were the most expensive and the cheapest procedure, respectively. No statistically significant difference was observed in terms of number of complications (p=.06) and presence of SDOH (p=.07) among the treatment groups. At multivariable analysis, patients with SDOH undergoing MIRN had higher odds of perioperative complications, while RA had a significantly lower probability of perioperative complications. ConclusionsThis study describes the current management of kidney cancer in the US, offering a socioeconomic perspective on the impact of this disease in everyday clinical practice. Data AvailabilityRaw data generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Computer Vision and Machine-Learning Techniques for Automatic 3D Virtual Images Overlapping During Augmented Reality Guided Robotic Partial Nephrectomy.

The research's purpose is to develop a software that automatically integrates and overlay 3D virtual models of kidneys harboring renal masses into the Da Vinci robotic console, assisting surgeon during the intervention. Precision medicine, especially in the field of minimally-invasive partial nephrectomy, aims to use 3D virtual models as a guidance for augmented reality robotic procedures. However, the co-registration process of the virtual images over the real operative field is performed manually. In this prospective study, two strategies for the automatic overlapping of the model over the real kidney were explored: the computer vision technology, leveraging the super-enhancement of the kidney allowed by the intraoperative injection of Indocyanine green for superimposition and the convolutional neural network technology, based on the processing of live images from the endoscope, after a training of the software on frames from prerecorded videos of the same surgery. The work-team, comprising a bioengineer, a software-developer and a surgeon, collaborated to create hyper-accuracy 3D models for automatic 3D-AR-guided RAPN. For each patient, demographic and clinical data were collected. Two groups (group A for the first technology with 12 patients and group B for the second technology with 8 patients) were defined. They showed comparable preoperative and post-operative characteristics. Concerning the first technology the average co-registration time was 7 (3-11) seconds while in the case of the second technology 11 (6-13) seconds. No major intraoperative or postoperative complications were recorded. There were no differences in terms of functional outcomes between the groups at every time-point considered. The first technology allowed a successful anchoring of the 3D model to the kidney, despite minimal manual refinements. The second technology improved kidney automatic detection without relying on indocyanine injection, resulting in better organ boundaries identification during tests. Further studies are needed to confirm this preliminary evidence.

Operative duration as independent predictor of increased postoperative healthcare utilization.

Few studies have examined the risk factors for postoperative healthcare resource utilization (HRU) among minimally invasive partial nephrectomy (MIPN), minimally invasive prostatectomy (MIP), and cystectomy (Cx). The aim of this study is to assess if operative duration (OD) is a predictor of HRU in this population. The ACS-NSQIPdatabase was filtered for MIPN, MIP, and Cx. Patient characteristics and intraoperative variableswere examined. HRU was defined as prolonged length of stay (LOS), unplanned readmission within 30days, and discharge to continued care facility. Multivariate regression analysis was used to identify independent predictors of HRU. 18,904 MIPN, 50,807 MIP, and 12,451 Cx were included. For MIPN, HRU was seen in 13.9% of cases < 1.75h, increasing to 36.2% in OD > 4.5h (p < 0.001). For MIP, HRU was seen in 10.6% of OD < 2h, increasing to 32.2% for OD > 4.9h (p < 0.001). For Cx, 57% of those with OD > 8.5h required HRU compared to 42.1% for OD < 3.3h (p < 0.001). On multivariate analyses, OD wasan independent predictor for increased HRU for all procedures regardless of patient characteristics or comorbidities. For MIPN, OD > 4.5h had 3.5-fold increased use of HRU (p < 0.001). For MIP, OD > 5h had 3.7-fold increased use of HRU (p < 0.001). For Cx, OD > 8.5h demonstrated a twofold increased use of HRU (p < 0.001). OD during MIPN, MIP, and Cx is an independent predictor of increased HRU irrespective of patient comorbidities. Patients with OD > 4.5h for MIPN, > 5h for MIP, and > 8.5h for Cx have 3.5-fold, 3.7-fold, and twofold increased risk of HRU, respectively.

VE69 - Initial experience in Minimally Invasive Partial Nephrectomy (MIPN) with the new Versius Robotic Platform (VRP)

VE69 - Initial experience in Minimally Invasive Partial Nephrectomy (MIPN) with the new Versius Robotic Platform (VRP)

Three-dimensional models-assisted minimally-invasive partial nephrectomy: looking forward to more evidence.

Three-dimensional models-assisted minimally-invasive partial nephrectomy: looking forward to more evidence.

Perioperative, functional, and oncologic outcomes of minimally-invasive surgery for highly complex renal tumors (RENAL or PADUA score ≥ 10): an evidence-based analysis.

The primary objective of the current study is to undertake a comparative analysis of the effectiveness and safety of minimally-invasive partial nephrectomy (MIPN; including laparoscopic and robotic approaches) and open partial nephrectomy (OPN) for the treatment of highly complex renal tumors (defined as PADUA or RENAL score ≥ 10). A comprehensive search was conducted in four electronic databases (PubMed, Web of Science, Embase, and Cochrane Library) to identify relevant studies published in the English language up to April 2023. The current study employed Review Manager 5.4 and encompassed controlled trials of both MIPN and OPN for the treatment of highly complex renal tumors. This study comprised a total of eight comparative trials involving 1161 patients. MIPN demonstrated a significant reduction in length of hospital stay (weighted mean difference [WMD] - 2.08days, 95% confidence interval [CI] - 2.48, - 1.68; p < 0.00001), blood loss (WMD - 39.86mL, 95% CI - 75.32, - 4.39; p = 0.03), transfusion rates (odds ratio [OR] 0.30, 95% CI 0.13, 0.71; p = 0.006), and overall complications (OR 0.46, 95% CI 0.31, 0.70; p = 0.0003). However, there were no significant differences between MIPN and OPN in terms of operative time, warm ischemia time, conversion to radical nephrectomy rates, renal functional and oncologic outcomes. This study reveals that MIPN presents several benefits in comparison to OPN, including decreased length of hospital stay, blood loss, transfusion rates, and complications, while still offering renal functional and oncological outcomes that are comparable to those of OPN in patients with highly complex renal tumors.

Comparison between minimally invasive partial nephrectomy and open partial nephrectomy for complex renal tumors: a systematic review and meta-analysis.

The present study aimed to conduct a pooled analysis to compare the efficacy and safety of minimally invasive partial nephrectomy (MIPN) with open partial nephrectomy (OPN) in patients with complex renal tumors (defined as PADUA or RENAL score ≥7). The present study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, Supplemental Digital Content 1, http://links.lww.com/JS9/A394 . We conducted a systematic search of the PubMed, Embase, Web of Science, and Cochrane Library databases until October 2022. MIPN and OPN-controlled trials for complex renal tumors were included. The primary outcomes were perioperative results, complications, renal function, and oncologic outcomes. A total of 2405 patients were included in 13 studies. MIPN outperformed OPN in terms of hospital stay [weighted mean difference (WMD) -1.84 days, 95% CI -2.35 to -1.33; P <0.00001], blood loss (WMD -52.42ml, 95% CI -71.43 to -33.41; P <0.00001), transfusion rates [odds ratio (OR) 0.34, 95% CI 0.17-0.67; P =0.002], major complications (OR 0.59, 95% CI 0.40-0.86; P =0.007) and overall complications (OR 0.43, 95% CI 0.31-0.59; P <0.0001), while operative time, warm ischemia time, conversion to radical nephrectomy rates, estimated glomerular decline, positive surgical margins, local recurrence, overall survival, recurrence-free survival, and cancer-specific survival were not significantly different. The present study demonstrated that MIPN was associated with a shorter length of hospital stay, less blood loss, and fewer complications in treating complex renal tumors. MIPN may be considered a better treatment for patients with complex tumors when technically feasible.

MP58-10 INSTITUTIONAL ANALYSIS OF TRIFECTA DEFINITIONS: 3D VIRTUAL MODELS PREDICT HIGHER RATES OF 'SUCCESSFUL' MINIMALLY INVASIVE PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP58-10 INSTITUTIONAL ANALYSIS OF TRIFECTA DEFINITIONS: 3D VIRTUAL MODELS PREDICT HIGHER RATES OF 'SUCCESSFUL' MINIMALLY INVASIVE PARTIAL NEPHRECTOMY Daniele Amparore, Angela Pecoraro, Federico Piramide, Enrico Checcucci, Sabrina De Cillis, Alberto Piana, Gabriele Volpi, Davide Zamengo, Alberto Quarà, Giovanni Busacca, Marco Colombo, Dalia Cidda, Cecilia Gatti, Michele Ortenzi, Martina Mandaletti, Michele Sica, Paolo Verri, Matteo Manfredi, Cristian Fiori, and Francesco Porpiglia Daniele AmparoreDaniele Amparore More articles by this author , Angela PecoraroAngela Pecoraro More articles by this author , Federico PiramideFederico Piramide More articles by this author , Enrico CheccucciEnrico Checcucci More articles by this author , Sabrina De CillisSabrina De Cillis More articles by this author , Alberto PianaAlberto Piana More articles by this author , Gabriele VolpiGabriele Volpi More articles by this author , Davide ZamengoDavide Zamengo More articles by this author , Alberto QuaràAlberto Quarà More articles by this author , Giovanni BusaccaGiovanni Busacca More articles by this author , Marco ColomboMarco Colombo More articles by this author , Dalia CiddaDalia Cidda More articles by this author , Cecilia GattiCecilia Gatti More articles by this author , Michele OrtenziMichele Ortenzi More articles by this author , Martina MandalettiMartina Mandaletti More articles by this author , Michele SicaMichele Sica More articles by this author , Paolo VerriPaolo Verri More articles by this author , Matteo ManfrediMatteo Manfredi More articles by this author , Cristian FioriCristian Fiori More articles by this author , and Francesco PorpigliaFrancesco Porpiglia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003311.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 3D virtual models (3DVMs) are nowadays under scrutiny to improve partial nephrectomy (PN) outcomes. Over the year, five different Trifecta definitions have been proposed to optimize the framing of “success” in the PN field. The aim of the present study was to analyze if the use of 3DVMs could impact the success rate of minimally-invasive PN, according to the currently available definitions of Trifecta. METHODS: At our Institution 250 cT1-2N0M0 renal masses patients treated with minimally-invasive PN were prospectively enrolled. Inclusion criteria were the availability of contrast-enhanced CT from which a 3DVM was obtained, baseline and postoperative serum creatinine, and eGFR. These patients were then compared with a control group of 710 patients who underwent minimally-invasive PN with the same renal function assessments, but without 3DVMs. Trifecta rate was defined for each of the currently available definitions, after stratification according to 3DVMs availability. Multivariable logistic regression (MLR) models were used to predict the trifecta achievement according to the different trifecta definitions. RESULTS: Overall, 960 patients met the inclusion criteria. Among the definitions, Trifecta rates ranged between 70.8% to 97.4% in the 3DVM group vs. 56.8% to 92.8% in the control group (all p values<0.05). 3DVMs showed better postoperative outcomes in terms of ΔeGFR, (-16.6% vs. -2.7%, p=0.03), postoperative complications (15%, vs 22.9%, p=0.002) and major complications (Clavien Dindo >3, 2.8% vs 5.6%, p=0.03). At MLR 3DVMs assistance independently predicted higher rates of successful PN across all the available definitions of Trifecta (OR: 2.7 p<0.001, OR:2.0 p=0.0008, OR:2.8 p=0.02, OR 2.0 p=0.003). CONCLUSIONS: There was large variability in the rates of Trifecta according to different definitions, but always in favor of those PN assisted by 3DVMs. Their availability was found to be the constant predictive factor of successful PN, with a 2-fold higher probability of achieving Trifecta regardless of the different definitions available in Literature and justifying their introduction in clinical practice. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e799 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniele Amparore More articles by this author Angela Pecoraro More articles by this author Federico Piramide More articles by this author Enrico Checcucci More articles by this author Sabrina De Cillis More articles by this author Alberto Piana More articles by this author Gabriele Volpi More articles by this author Davide Zamengo More articles by this author Alberto Quarà More articles by this author Giovanni Busacca More articles by this author Marco Colombo More articles by this author Dalia Cidda More articles by this author Cecilia Gatti More articles by this author Michele Ortenzi More articles by this author Martina Mandaletti More articles by this author Michele Sica More articles by this author Paolo Verri More articles by this author Matteo Manfredi More articles by this author Cristian Fiori More articles by this author Francesco Porpiglia More articles by this author Expand All Advertisement PDF downloadLoading ...

V05-05 3D SURGICAL PLANNING IN PARTIAL NEPHRECTOMY FOR COMPLETELY ENDOPHYTIC TUMORS

You have accessJournal of UrologyCME1 Apr 2023V05-05 3D SURGICAL PLANNING IN PARTIAL NEPHRECTOMY FOR COMPLETELY ENDOPHYTIC TUMORS Patricio Garcia, Jorge Abril, Tomas Carminatti, Angelica Castillo, Sebastian Tirapegui, and Alberto Jurado Patricio GarciaPatricio Garcia More articles by this author , Jorge AbrilJorge Abril More articles by this author , Tomas CarminattiTomas Carminatti More articles by this author , Angelica CastilloAngelica Castillo More articles by this author , Sebastian TirapeguiSebastian Tirapegui More articles by this author , and Alberto JuradoAlberto Jurado More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003263.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: When we talk about precision surgery, it is necessary to have adequate preoperative planning. 3D technology allows us to locate renal lesions that are difficult to access, and in this way generate less damage to the uncompromised parenchyma.In recent years it has been seen that the incorporation of 3D models could improve surgical results, the learning curves of novice surgeons and also the understanding of patients.In Urology, the use of surgical planning with 3D models and simulation is mainly used in renal tumors. The objetive is to present a series of cases of completely endophytic renal tumors with 3D models created for surgical planning. METHODS: We present a series of 5 cases with 3D models created for surgical planning. Case #1A 47-year-old female patient with congenital solitary kidney, presents an incidental renal tumor of 2 cm completely endophytic in contact with the renal sinus, it is a R.E.N.A.L Score 9x. It was performed by lumboscopic approachCase #2 A 60-year-old male patient with bilateral renal tumors, has a Left renal exophytic formation and completely endophytic right renal lesion of 2 cm R.E.N.A.L. Score 10p. The exophytic left renal tumor was treated 3 months before. It was performed by a lumboscopic approach.Case #3A 61-year-old female patient with a completely endophytic mesorenal lesion in the left kidney of 2.5cm R.E.N.A.L. Score 12x. In this patient we performed a transperitoneal approach Case #4A 54-year-old male patient with a completely endophytic mesorenal lesion in the left kidney of 3cm R.E.N.A.L. score 12x. It was performed by a lumboscopic approach.Case #5. A 45-year-old male patient with a completely endophytic mesorenal lesion in the left kidney of 2.5 cm. RENAL Score 12x. In this patient we performed a transperitoneal approach RESULTS: In our hospital we did 21 minimally-invasive partial nephrectomy for completely endophytic tumors between 2010 to 2022. In the last year we incorporated the use of 3D technology for surgical planning in these cases.The average days of hospitalization was 2, 9. In the pathology reports, the majority of tumors were Clear-cell RCC and pT1a. Two patients had postoperative complications with Clavien dindo III.Negative margins, warm ischemia time <25 minutes, and postoperative glomerular filtration rate <15% were established as cut-off points with respect to the strict Trifecta criteria to ensure optimal preservation of renal function. We achieved strict trifecta results in 16 patients (76.19%) CONCLUSIONS: In our case series, 3D models seem to be useful for surgical planning and provide us with more tools to perform precision surgeries. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e425 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patricio Garcia More articles by this author Jorge Abril More articles by this author Tomas Carminatti More articles by this author Angelica Castillo More articles by this author Sebastian Tirapegui More articles by this author Alberto Jurado More articles by this author Expand All Advertisement PDF downloadLoading ...

Robotic Off-Clamp Simple Enucleation Single-Layer Renorrhaphy Partial Nephrectomy (ROSS): Surgical Insights after an Initial Experience

Robotic technology allows the beginner surgeon to approach minimally-invasive partial nephrectomy (PN) avoiding the otherwise long learning curve of pure laparoscopy. The present video-article reported the surgical technique and the outcomes of the first 11 cases performed by a young surgeon starting with the experience of robotic PN. Transperitoneal robotic PN, with an off-clamp approach, a simple enucleation technique, and a single-layer medullar renorrhaphy was performed uneventfully in all cases but one, with comparable outcomes to the available literature. With the present experience, we are trying to give the reader a different point of view of the current knowledge. In our series, off-clamp robotic PN was not chosen while looking for a better functional outcome, but rather as a "forced" choice within the specific "in training" setting the interventions were performed in. We underline how the off-clamp approach was the way to cut out the potential for vascular complications derived from the application/removal of the clamp itself on the renal artery. Indeed, when Scanlan bulldogs are not available, one of the limits of robotic PN is that the first surgeon is not autonomous in placing/removing the clamp. We found that tumour enucleation resection technique had the perfect synergistic effect in maximizing the perioperative vision, and thus the safety, notwithstanding the clampless approach.

SC177 - 3D virtual models assistance predicts higher rates of “successful” minimally-invasive partial nephrectomy: an institutional analysis across the available trifecta definitions

SC177 - 3D virtual models assistance predicts higher rates of “successful” minimally-invasive partial nephrectomy: an institutional analysis across the available trifecta definitions

Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy

ObjectiveWe conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre- and peri-operative variables associated with length of stay (LOS) greater than 3 days and readmission within 30 days. MethodsRecords from 2008 to 2018 for “laparoscopy, surgical; partial nephrectomy” for prolonged LOS and readmission cohorts were compiled. Univariate analysis with Chi-square, t-tests, and multivariable logistic regression analysis with odds ratios (ORs), p-values, and 95% confidence intervals assessed statistical associations. ResultsTotally, 20 306 records for LOS greater than 3 days and 15 854 for readmission within 30 days were available. Univariate and multivariable analysis exhibited similar results. For LOS greater than 3 days, undergoing non-elective surgery (OR=5.247), transfusion of greater than four units within 72 h prior to surgery (OR=5.072), pre-operative renal failure or dialysis (OR=2.941), and poor pre-operative functional status (OR=2.540) exhibited the strongest statistically significant associations. For hospital readmission within 30 days, loss in body weight greater than 10% in 6 months prior to surgery (OR=2.227) and bleeding disorders (OR=2.081) exhibited strongest statistically significant associations. ConclusionMultiple pre- and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data. Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection, optimization strategies, and patient education.

Same-day discharge following minimally invasive partial and radical nephrectomy: a National Surgical Quality Improvement Program (NSQIP) analysis.

Minimally invasive partial nephrectomy (MIPN) and radical nephrectomy (MIRN) have successfully resulted in shorter length of stay (LOS) for patients. Using a national cohort, we compared 30-day outcomes of SDD (LOS = 0) versus standard-length discharge (SLD, LOS = 1-3) for MIRN and MIPN. All patients who underwent MIPN (CPT 50,543) or MIRN (CPT 50,545) in the ACS-NSQIP database from 2012 to 2019 were reviewed. SDD and SLD groups were matched 1:1 by age, sex, race, body mass index, American Society of Anesthesiologists score, and medical comorbidities. We compared baseline characteristics, 30-day Clavien-Dindo (CD) complications, reoperations, and readmissions between SDD and SLD groups. Multivariable logistic regressions were used to evaluate predictors of adverse outcomes. 28,140 minimally invasive nephrectomy patients were included (SDD n = 237 [0.8%], SLD n = 27,903 [99.2%]). There were no significant differences in 30-day readmissions, CD I/II, CDIII, or CD IV complications before and after matching SDD and SLD groups. On multivariate regression analysis, SDD did not confer increased risk of 30-day complications or readmissions for both MIPN and MIRN. SDD after MIPN and MIRN did not confer increased risk of postoperative complications, reoperation, or readmission compared to SLD. Further research should explore optimal patient selection to ensure safe expansion of this initiative.

Three-dimensional imaging reconstruction of the kidney's anatomy for a tailored minimally invasive partial nephrectomy: A pilot study

ObjectiveThe aim of the study was to evaluate three-dimensional virtual models (3DVMs) usefulness in the intraoperative assistance of minimally-invasive partial nephrectomy in highly complex renal tumors. MethodsAt our institution cT1-2N0M0 all renal masses with Preoperative Aspects and Dimensions Used for an Anatomical classification score ≥10 treated with minimally-invasive partial nephrectomy were considered for the present study. For inclusion a baseline contrast-enhanced computed tomography in order to obtain 3DVMs, the baseline and postoperative serum creatinine as well as estimated glomerular filtration rate values were needed. These patients, in which 3DVMs were used to assist the surgeon in the planning and intraoperative guidance, were then compared with a control group of patients who underwent minimally-invasive partial nephrectomy with the same renal function assessments, but without 3DVMs. Multivariable logistic regression models were used to predict the margin, ischemia, and complication score achievement. ResultsOverall, 79 patients met the inclusion criteria and were compared with 143 complex renal masses without 3DVM assistance. The 3DVM group showed better postoperative outcomes in terms of baseline-weighted differential estimated glomerular filtration rate (−17.7% vs. −22.2%, p=0.03), postoperative complications (16.5% vs. 23.1%, p=0.03), and major complications (Clavien Dindo >III, 2.5% vs. 5.6%, p=0.03). At multivariable logistic regression 3DVM assistance independently predicted higher rates of successful partial nephrectomy (odds ratio: 1.42, p=0.03). Conclusion3DVMs represent a useful tool to plan a tailored surgical approach in case of surgically complex masses. They can be used in different ways, matching the surgeon's needs from the planning phase to the demolitive and reconstructive phase, leading towards maximum safety and efficacy outcomes.

Predicting acute kidney injury following open partial nephrectomy treatment using SAT-pruned explainable machine learning model

BackgroundOne of the most prevalent complications of Partial Nephrectomy (PN) is Acute Kidney Injury (AKI), which could have a negative impact on subsequent renal function and occurs in up to 24.3% of patients undergoing PN. The aim of this study was to predict the occurrence of AKI following PN using preoperative parameters by applying machine learning algorithms.MethodsWe included all adult patients (n = 723) who underwent open PN in our department since 1995 and on whom we have data on the pre-operative renal function. We developed a random forest (RF) model with Boolean satisfaction-based pruned decision trees for binary classification (AKI or non-AKI). Hyper-parameter grid search was performed to optimize the model's performance. Fivefold cross-validation was applied to evaluate the model. We implemented a RF model with greedy feature selection to binary classify AKI and non-AKI cases based on pre-operative data.ResultsThe best model obtained a 0.69 precision and 0.69 recall in classifying the AKI and non-AKI groups on average (k = 5). In addition, the model's probability to correctly classify a new prediction is 0.75. The proposed model is available as an online calculator.ConclusionsOur model predicts the occurrence of AKI following open PN with (75%) accuracy. We plan to externally validate this model and modify it to minimally-invasive PN.

MP24-20 ANALYSIS OF PREDICTORS OF sCKD PROGRESSION AFTER MINIMALLY-INVASIVE IMPERATIVE PARTIAL NEPHRECTOMY IN PATIENTS WITH PREOPERATIVE CKD STAGE 3A: RESULTS OF A MULTI-INSTITUTIONAL COLLABORATIVE SERIES

MP24-20 ANALYSIS OF PREDICTORS OF sCKD PROGRESSION AFTER MINIMALLY-INVASIVE IMPERATIVE PARTIAL NEPHRECTOMY IN PATIENTS WITH PREOPERATIVE CKD STAGE 3A: RESULTS OF A MULTI-INSTITUTIONAL COLLABORATIVE SERIES

Propensity-score matched oncological outcomes and patterns of recurrence following open and minimally-invasive partial nephrectomy for renal cell carcinoma.

Oncological equivalency of minimally-invasive partial nephrectomy compared to open partial nephrectomy (OPN) continues to be challenged by proponents of open urologic oncology surgery. To compare patterns of recurrence, recurrence-free survival, cancer-specific survival, and overall survival between patients who underwent open or minimally-invasive partial nephrectomy. Data from prospectively maintained databases from 2 urban quaternary referral centers was retrospectively collected from 2003 to 2018. Patients who underwent either open or minimally-invasive (laparoscopic or robotic-assisted) partial nephrectomy and found to have malignant pathology were included. The groups subsequently underwent propensity-score matching to ensure homogeneity prior to analysis. The primary outcomes were incidence of recurrence, time to recurrence, time from recurrence to death, location of recurrence, and recurrence-free survival. Secondary outcomes included overall survival and cancer-specific survival. A total of 190 patients underwent OPN and 190 underwent minimally-invasive partial nephrectomy. Recurrence was more common in patients undergoing OPN (10% vs. 3.2%, P = 0.01), but surgical approach was not predictive of location of recurrence (P = 1) or time to recurrence (23.8 vs. 26.3 months, P = 0.73). All-cause mortality was more common in the OPN group (10.5% vs. 2.6%, P = 0.003). On multivariable analysis, only surgical approach was associated with increased risk for recurrence (OR 3.88, P = 0.009). This propensity-score matched analysis of patients undergoing partial nephrectomy suggests that minimally invasive surgical approach is resulted in decreased risk of recurrence and overall survival, and does not increase the risk for atypical sites of recurrence.

Is Hypertension Associated with Worse Renal Functional Outcomes after Minimally Invasive Partial Nephrectomy? Results from a Multi-Institutional Cohort

Background: Hypertension (HTN) is a global public health issue. There are limited data regarding the effects of HTN in patients undergoing partial nephrectomy (PN) for renal tumors. To address this void, we tested the association between HTN and renal function after minimally invasive PN (MIPN). Methods: Using a multi-institutional database (2007–2017), we identified patients aged ≥ 18 years with a diagnosis of cT1 renal tumors treated with MIPN. Kaplan–Meier plots and Cox regression models addressed newly-onset CKD stage ≥ 3b or higher (sCKD). All analyses were repeated after 1:1 propensity score matching (PSM). Results: Overall, 2144 patients were identified. Of those, 35% (n = 759) were yes-HTN. Yes-HTN patients were older, more frequently male and more often presented with diabetes. Yes-HTN patients harbored higher RENAL nephrometry scores and higher cT stages than no-HTN patients. Conversely, yes-HTN patients exhibited lower preoperative eGFRs. In the overall cohort, five-year sCKD-free survival was 86% vs. 94% for yes-HTN vs. no-HTN, which translated into a multivariable HR of 1.67 (95% CI: 1.06–2.63, p = 0.026). After 1:1 PSM, virtually the same results were observed (HR 1.86, 95% CI: 1.07–3.23, p = 0.027). Conclusions: Yes-HTN patients exhibited worse renal function after MIPN when compared to their no-HTN counterparts. However, these observations need to be further tested in a prospective cohort study.

V52 - Minimally-invasive partial nephrectomy employing 4K visualization system with OPAL 1 near-Infrared and indocyanine green technology

V52 - Minimally-invasive partial nephrectomy employing 4K visualization system with OPAL 1 near-Infrared and indocyanine green technology

Short-Term and Long-Term Renal Outcomes in Patients With Obesity After Minimally Invasive Versus Open Partial Nephrectomy for the Treatment of Renal Cancer: Retrospective Study.

BackgroundObesity is significantly associated with renal cell carcinoma. Surgery is the preferred treatment for demarcated lesions of renal cell carcinoma; however, obesity increases the complexity of surgical outcomes. Minimally invasive surgical techniques are preferred over open partial nephrectomy (OPN), but controversy remains regarding the most efficacious technique in patients with obesity.ObjectiveThis study aims to determine whether minimally invasive partial nephrectomy (MIPN) or OPN better preserves renal function and investigate short- and long-term renal outcomes in patients with obesity undergoing a partial nephrectomy.MethodsWe conducted a retrospective chart review of 242 adult patients aged ≥18 years who underwent MIPN or OPN between January 1, 2005, and December 31, 2016, at the University of Arkansas for Medical Sciences. Using creatinine as a measure of kidney function, patients’ preoperative levels were compared with their postoperative levels in 2-time frames: short (3-6 months postsurgery) or long (>6 months). The primary outcome was the change in creatinine values from preoperative to >6 months postoperatively in patients with obesity. Secondary outcomes included the change in creatinine values from preoperative to 3 to 6 months postoperatively in patients with obesity who underwent MIPN versus OPN. We also analyzed the creatinine values of nonobese patients (BMI <30) who underwent partial nephrectomy using the same time frames. Unconditional logistic regression was used to estimate crude and multivariable-adjusted odds ratios (ORs) and 95% CI to observe associations between surgery type and changes in creatinine values from while stratifying for obesity.ResultsA total of 140 patients were included in the study, of whom 75 were obese and 65 were nonobese. At >6 months after MIPN (n=20), the odds of patients with obesity having a decrease or no change in creatinine values was 1.24 times higher than those who had OPN (n=13; OR 1.24, 95% CI 0.299-6.729; P=.80). At 3 to 6 months after MIPN (n=27), the odds were 0.62 times lower than those after OPN (n=17; OR 0.62, 95% CI 0.140-2.753; P=.56). In the nonobese group, at 3 to 6 months after undergoing minimally invasive surgery (n=18), the odds of having a decrease or no change in creatinine values was 4.86 times higher than those who had open surgery (n=21; OR 4.86, 95% CI 1.085-21.809; P=.04). At more than 6 months after MIPN (n=14), the odds were 4.13 times higher than those after OPN (n=11; OR 4.13, 95% CI 0.579-29.485; P=.16).ConclusionsWe observed a nonstatistically significant preservation of renal function in patients with obesity who underwent OPN at 3 to 6 months postoperatively. Conversely, after 6 months, the same was true for MIPN, indicating the long-term benefit of MIPN. In the nonobese group, MIPN was favored over OPN.