Surgery For Renal Tumors Research Articles

Kidney autotransplantation after nephrectomy and work bench surgery as an ultimate approach to nephron-sparing surgery

BackgroundKidney autotransplantation (KAT) is the ultimate approach for nephron-sparing surgery. It is a rarely used method in renal tumor surgery today as minimal invasive and open techniques for nephron-sparing surgery improve constantly. In this publication, the complication rate and the long-term functional and oncological outcome at a single center are analyzed.MethodsA prospectively constructed database of patients with renal tumors who underwent renal surgery was retrospectively analyzed to identify patients with KAT and describe surgical and oncological outcomes and to obtain long-term follow-up. Data collection included detailed surgical technique, complications (Clavian-Dindo), and hospital stay, as well as functional and oncological outcome and long-term follow-up.ResultsBetween 1976 and 2013, 12 patients (median age 50.5 years) underwent KAT for highly complex renal masses: in five cases for complex renal cell carcinoma (RCC), five cases for complex upper urinary tract carcinoma (UTUC), one case for a renal metastasis, and one case for nephroblastoma. The nephrectomy or nephron-ureterectomy was performed open via a flank or transabdominal. The median surgical time was 360 min (range 270–490 min). Intraoperatively, six cases required blood transfusions (50%). Six patients (50%) developed significant postoperative complications (Clavian-Dindo > 2). In two patients, intermittent hemodialysis for delayed graft function (16.6%) was needed, and in six cases (50%), additional blood transfusions postoperatively were necessary. At discharge from hospital, all patients had functioning grafts. The median hospital stay was 29.5 days (range 18–35).At follow-up (median follow-up of 83.5 ± 40.7 months), six patients had died (50%)—all with functioning grafts (free from hemodialysis). In five cases, recurrence of primary tumor or metastatic disease was recorded. In four cases, the recurrent carcinoma could be resected; in detail, UTUC in three cases and one partial nephrectomy of the autotransplanted kidney was performed. One patient suffered from bone and lung metastasis. Two patients died finally tumor-related. Five patients (41.6%) are presently alive, without evidence of tumor relapse. One patient developed terminal renal failure requiring hemodialysis 105 months after autotransplantation. One additional patient was lost to follow-up; after 69 months, this patient had a functioning kidney and no evidence of disease-recurrence at the last follow-up. A cumulative number of 1424 months without hemodialysis was gained for these 12 patients.In the literature to date, most KAT are performed in benign disease, with minor but frequent complication. Here, we report the largest series of KAT for malignant kidney tumors. The complication rates are similar, compared to the recently reported series for benign indications with an improved graft survival rate. Since KAT requires a complex and challenging surgical approach, it should be performed by experienced kidney transplant surgeons.ConclusionIn very complex cases involving renal tumors and multi-morbidity, patients should be counseled well before KAT is considered. At the same time, KAT should not be abandoned in these very rare cases, especially when a nephron-sparing approach is otherwise not feasible. KAT can maintain renal function and quality of life and extend expectancy of life.

Coexistence of different histotypes of renal carcinoma:our experience and literature review

The coexistence of multiple, synchronous primary tumors of different histology within the same kidney is a rare condition. We report herein a series of five patients with two tumors of different histology involving synchronously the same kidney. MATERIALS AND METHODS. We reviewed the pathology reports of a series of 381 patients who underwent surgery for primary renal tumors at our institution from 2000 to 2007. In the files of all patients with synchronous tumors of different histology, special attention was given to the results of imaging studies. RESULTS. Five out of 381 patients (1.37%) had coexistence of two primary tumors of different histology within the same kidney. Four patients had ultrasonography as the first imaging procedure, one patient had ultrasonography as the second imaging procedure; all had preoperative CT of the abdomen. Both lesions were detected by preoperative CT in 4/5 of the cases; in the remaining one, the smaller lesion was not visible, even in retrospect. CONCLUSIONS. The coexistence of multiple and synchronous primary tumors of different histology within the same kidney has been only rarely described. To the best of our knowledge, in literature there are only case reports with the exception of a case of renal oncocytoma with evolving papillary RCC. We believe that this condition could be more frequent if the radiologist and the anatomopathologist try to find it.

Multiloculated Cystic Renal Tumors of Childhood: Has the Final Word Been Spoken.

Background:Multicystic renal tumors which include cystic nephroma, cystic partially differentiated nephroblastoma (CPDN) and cystic Wilms tumor has been a diagnostic and therapeutic challenge. Histopathological examination has been the only reliable differentiating method. Management of these tumors is still riddled with controversy as a definitive preoperative differentiation between the three has not been possible.Methods:A retrospective evaluation was performed of the treatment strategies employed with nine cases of multicystic renal tumors treated from 2005 to 2015.Results:The median age at presentation was 12 months with all except one being boys. All except two children underwent primary surgery. The median follow-up was 50 months with six children having long-term survival. One child succumbed to the disease process, one died due to an unrelated cause and another was lost to follow-up. Although there was no ambiguity with cases of cystic nephroma (CN) and cystic Wilms tumor, three of the four cases of CPDN had problems.Conclusion:Primary surgery for multicystic renal tumors is safe and should be seriously considered as it prevents overtreatment in cases of CN and early stage CPDN. Further studies are needed to fully understand the biological behavior of CPDN.

Robotic-assisted Laparoscopic Partial Nephrectomy in a Horseshoe Kidney. A Case Report and Review of the Literature

Horseshoe kidney is a rare renal fusion anomaly, and because of limited mobilization of the kidney and its multiple arterial blood supplies, minimally invasive surgery for renal tumors can be challenging. We describe a case of a right-side oncocytoma in a horseshoe kidney managed robotically and review the literature of robotic-assisted laparoscopic surgical resection of kidney tumors in renal fusion anomalies. Robotic-assisted laparoscopic partial nephrectomy in a horseshoe kidney is feasible. Fusion-related limited mobility during the procedure, as well as an extremely variable blood supply, require meticulous planning. Multi-phase computed tomography and interactive 3D anatomical models are helpful tools to prepare for surgery.

The unique characteristics of intussusception after renal tumor surgery in children

Abstract Introduction To further optimize survival rates as well as quality of cure for pediatric kidney tumors, attention for treatment related morbidity and mortality has become increasingly important. Intussusception is a rare but important complication after tumornephrectomy in children, causing morbidity, mortality and prolonged hospitalization. In this study, we describe two recent cases in our institute and provide a comprehensive review of the literature. Methods For our narrative review, we searched for all reported cases of post tumor nephrectomy intussusception published until November 2016, using Pubmed and Embase libraries. Results A total of 52 pediatric renal tumor cases who developed intussusception after tumor nephrectomy were identified. Median age was 23 months (range 3–84). Median time of onset was postoperative day 6 (range 1–18). Of 41 patients described in detail, only 4/41 were ileocolic, the others suffered from a small bowel intussusception. Most frequent presenting symptom was bilious vomiting. Preceding treatment approach was documented in 47 cases; i.e. preoperative chemotherapy had been administered to 10/47 patients. In 29 of 30 well documented cases, successful manually reduction during re-laparotomy was described and only 1 patient needed resection. All patients survived without recurrence of intussusception. Conclusion In pediatric renal tumor patients, small bowel obstruction seems to reflect mostly post nephrectomy intussusception cases in contrast to the ileocolic idiopathic intussusceptions that are observed in healthy children. Symptoms of intussusception mimic chemotherapy related toxicity and general post-surgical symptoms, thereby initiating a significant delay in diagnosis. Awareness of intussusception after renal tumor surgery is warranted.

Current state of renal tumor surgery among pediatric surgeons and pediatric urologists: A survey of American Pediatric Surgical Association (APSA) and Society for Pediatric Urology (SPU) members

Anecdotally, renal tumor (RT) surgery makes up a limited portion of the practice for most pediatric urologists and pediatric surgeons. Data are lacking on the current perceptions of RT surgery, both volume of surgery and issues related to surgical practice, among pediatric surgeons (PS) and pediatric urologists (PU). To describe practice patterns of pediatric renal tumor (RT) surgery and identify factors related to higher reported volumes of RT surgery. The survey was developed and pilot-tested by the Children's Oncology Group (COG) RT surgery committee. The survey was distributed to APSA and SPU members. Logistic regression was performed to correlate surgeon-reported factors with higher reported volumes of RT surgery. The survey was sent to 1,282 APSA and 426 SPU members, 367 (21.5%) surveys were completed from eligible responders, 244 (65.2%) and 123 (32.9%) from APSA and SPU invitations, respectively. Overall, 33.9% reported being part of a practice group in which RT surgical care is sub-specialized. A majority (50.7%) of respondents reported personally performing one to two RT surgeries annually, and 16.7% reported performing none. Multivariate logistic regression identified the following significant factors associated with increased individual RT surgical volume: group sub-specialization, COG/SIOP membership, regular tumor board attendance, and annual institutional volume >10 RT surgeries (Table). Accurate responses on the need for lymph node (LN) sampling in RT surgery were reported by 89.9%. Overall, 15.8% and 24.5% of respondents failed to correctly correlate local stage III disease in Wilms tumor (WT) with open or percutaneous biopsy, respectively (p<0.001). While we found that reported RT surgery volume is low among both pediatric urologists and surgeons, we did identify surgeon-specific factors which correlated with higher RT surgical volume. Interested pediatric urologists and surgeons may use these data to tailor their practice if their goal is to increase RT surgery volume. Additionally, based on less than ideal rates of correct responses to nuance in the staging and treatment of WT, there are clear opportunities to increase education in this content area. However, the study is limited by use of a non-validated survey instrument and the relatively low response rates. Reported individual RT surgery volume is low. Factors associated with increased volume include sub-specialty practice, tumor board involvement, and higher institutional volume. Responses on LN sampling and biopsy in WT demonstrate opportunities for educational initiatives.

Polymer Ligating Clips in Urologic Laparoscopic Surgery

Introducing polymer ligating clips (PLC) or Hem-o-lok clips was a useful alternative to titanium clips in order to perform a safe, efficient and rapid ligation of the vascular structures during laparoscopic and/or conventional surgical procedures. In urologic surgery they are useful during ablative laparoscopic surgery for renal tumor, urothelial tumors, non-functional kidney, bladder tumors and prostate tumors. Polymers� properties depend on the structure of molecules and vary from flexible substances to expandable rigid materials. They have a high resistance to shock, considerable abrasion resistance and precise durability. Polymers can easily take the desired shape, due to different processing modes. They also have the property of resistance to sustainable action of external forces. The aim of this paper is to evaluate the efficacy and safety of PLC used during renal pedicle ligation in retroperitoneal laparoscopic nephrectomy for renal tumors, high urothelial tumors and nonfunctional kidney.

Solid Renal Masses in Transplanted Allograft Kidneys: A Closer Look at the Epidemiology and Management.

The objective of this review is to explore the available literature on solid renal masses (SRMs) in transplant allograft kidneys to better understand the epidemiology and management of these tumors. A literature review using PubMed was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Fifty-six relevant studies were identified from 1988 to 2015. A total of 174 SRMs in 163 patients were identified, with a mean tumor size of 2.75 cm (range 0.5-9.0 cm). Tumor histology was available for 164 (94.3%) tumors: clear cell renal cell carcinoma (RCC; 45.7%), papillary RCC (42.1%), chromophobe RCC (3%), and others (9.1%). Tumors were managed by partial nephrectomy (67.5%), radical nephrectomy (19.4%), percutaneous radiofrequency ablation (10.4%), and percutaneous cryoablation (2.4%). Of the 131 patients (80.3%) who underwent nephron-sparing interventions, 10 (7.6%) returned to dialysis and eight (6.1%) developed tumor recurrence over a mean follow-up of 2.85 years. Of the 110 patients (67.5%) who underwent partial nephrectomy, 3.6% developed a local recurrence during a mean follow-up of 3.12 years. The current management of SRMs in allograft kidneys mirrors management in the nontransplant population, with notable findings including an increased rate of papillary RCC and similar recurrence rates after partial nephrectomy in the transplant population despite complex surgical anatomy.

Contemporary treatment of renal tumors: a questionnaire survey in the Nordic countries (the NORENCA-I study)

Objective: The five Nordic countries comprise 25 million people, and have similar treatment traditions and healthcare systems. To take advantage of these similarities, a collaborative group (Nordic Renal Cancer Group, NORENCA) was founded in 2015.Materials and methods: A questionnaire of 17 questions on renal tumor management and surgical education was designed and sent to 91 institutions performing renal tumor surgery in 2015. The response rate was 68% (62 hospitals), including 28 academic, 25 central and nine district hospitals. Hospital volume was defined as low (LVH: < 20 operations), intermediate (IVH: 20–49 operations), high (HVH: 50–99) and very high (VHVH: ≥ 100). Descriptive statistics were performed.Results: Fifteen centers were LVH, 16 IVH, 21 HVH and 10 VHVH. Of all 3828 kidney tumor treatments, 55% were radical nephrectomies (RNs), 37% partial nephrectomies (PNs) and 8% thermoablations. For RN and PN, the percentages of open, laparoscopic and robotic approaches were 47%, 40%, 13% and 47%, 20%, 33%, respectively. The mean complication rate (Clavien–Dindo 3–5) was 4.9%, and 30 day mortality (TDM) was 0.5%. The median length of hospital stay was 4 days. Training with a simulator, black box or animal laboratory was possible in 48%, 74% and 21% of institutions, respectively.Conclusions: Despite some differences between countries, the data suggest an overall general common Nordic treatment attitude for renal tumors. Furthermore, the data demonstrate high adherence to international standards, with a high proportion of PN and acceptable rates for major complications and TDM.

Chronic Kidney Disease Is More Common in Locally Advanced Renal Cell Carcinoma

To retrospectively evaluate clinical predictors of chronic kidney disease (CKD) in renal cell carcinoma (RCC) patients to identify associations between patient- and tumor-specific factors with poorer renal function. CKD and RCC are interrelated, with 26%-44% of RCC patients having concomitant CKD at diagnosis. Institutional registries from Spectrum Health and University of California, San Diego, were queried for preoperative glomerular filtration rate and proteinuria status before radical or partial nephrectomy. Preoperative clinical and tumor factors were recorded; proteinuria was classified as A1 (<30 mg), A2 (30-300 mg), and A3 (>300 mg). CKD was grouped by Kidney Disease Improving Global Outcomes classification (low, moderately increased, high, very high). We evaluated 1569 patients undergoing surgery for renal cortical tumors. CKD status was low risk in 860 (55%), moderately increased in 381 (24%), high in 194 (12%), and very high in 134 (9%) patients. Increased radius, exophytic or endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior or posterior, location relative to polar lines score, tumor size, and clinical tumor stage were strongly associated with increased CKD risk at baseline. Clinical stage T3/T4 disease had more at-risk patients than stages T2 and T1 disease (39.5% vs 22% and 19%, P = .0001). Clinical tumor stage and gender were the only predictors of proteinuria, lower glomerular filtration rate, and higher CKD risk group in both univariate and multivariate analyses. Forty-five percent of patients with RCC had moderate or higher CKD before treatment. A positive correlation between pretreatment CKD and locally advanced RCC (cT3/T4) was present. This likely relates to increased loss of functional parenchyma with increasing tumor size or stage, with important implications in patient management.

CT detection of fat retention in the bladder after partial nephrectomy.

This study aimed to investigate the frequency of fat retention in the bladder using postoperative computed tomography (CT) and the associated imaging or clinical findings in patients who underwent renal tumor surgery. We retrospectively reviewed postoperative CT images from 123 patients who underwent surgery for renal tumors (92 patients after partial nephrectomy and 31 after total nephrectomy). Furthermore, we evaluated preoperative tumor characteristics per an established standardized nephrometry scoring system (the R.E.N.A.L Nephrometry Score) for patients with partial nephrectomy. We also investigated whether collecting system repair occurred during surgery. Fat retention in the bladder was found in 5 patients (5.4%) after partial nephrectomy, but was not observed in any patients after total nephrectomy. No fat retention was seen immediately after partial nephrectomy (4-8 days), but occurred 2-15 months after the surgery. Subsequently, intravesical fat retention disappeared in 3 patients (8, 24, and 16 months later), and it persisted from 19-22 months after surgery in the remaining 2 patients. Collecting system repair occurred in 25 patients (27%) with partial nephrectomy. There was no statistically significant association between fat retention in the bladder and intraoperative collecting system repair (p=0.12). The association with intravesical fat retention was not significant for either tumor size, distance to the collecting system, or the R.E.N.A.L. Nephrometry Score. Fat retention in the bladder after partial nephrectomy can be observed using CT, although it is relatively rare. It is clinically asymptomatic and disappears spontaneously in most cases.

Trends of partial and radical nephrectomy in managing small renal masses.

Use of partial nephrectomy (PN) for renal tumors appears to have relatively lower incidence rates in Jordan. We sought to characterize its trend at King Hussein Cancer Center for the last 10 years. A retrospective review of our renal cell cancer data was performed. We identified 169 patients who had undergone surgery for renal tumors measuring ≤7 cm between 2005 and 2015. We characterized tumor size, pathology, type of surgery and clinical outcomes. Factors associated with the use of PN were evaluated using univariable and multivariable logistic regression models. Of the 169 patients, 34 (20%) and 135 (80%) had undergone partial and radical nephrectomy (RN) respectively for tumors ≤7 cm in diameter. Total number of 48 patients with tumors of ≤4 cm in diameter had undergone either PN (n=19; 40%) or RN (n=29; 60%). The frequency of PN procedures steadily increased over the years from 6% in 2005-2008, to 32% in 2013-2015, contrary to RN which was less frequently applied 94% in 2005-2008, and 68% in 2013-2015. In multivariable analysis, delayed surgery (p=0.01) and smaller tumor size (p=0.0005) were significant independent predictors of PN. During follow-up period, incidence of metastasis was lower in PN versus RN (13% and 32%, respectively, p=0.043). Local recurrence rates were not significantly different between PN (6.9%) and RN (7.2%) (p=0.99). The mean tumor sizes for patients who had undergone PN and RN were 4.1 and 5.5 cm respectively, (p<0.0001). The mean follow-up period for PN was 20 months, and for RN 33 months, (p=0.0225). Partial nephrectomy for small renal tumors is relatively less frequently applied in Jordan, however an increase in its use has been observed over the years. Our data showed lower rates of distant metastasis and similar rates of local recurrence in favor of PN.

A Society for Pediatric Urology Workforce Survey on the Current Perceptions of Oncology Care by Pediatric Urologists: A Report from the Pediatric Urologic Oncology Working Group of the Society for Pediatric Urology

Data are lacking on the current perception of oncology care among pediatric urologists. Thus, we developed, pilot tested and administered a survey on this topic to SPU (Society for Pediatric Urology) members. Approval for this proposal was granted by SPU leadership prior to developing or distributing the survey instrument. The survey was developed and pilot tested by the PUOWG (Pediatric Urologic Oncology Working Group). Response data were collected and descriptive statistics were used for analysis. Logistic regression analysis was performed to correlate surgeon reportedfactors with higher volumes of reported oncology surgery. A total of 426 surveys were distributed via email to SPU members and 212 individual surveys (49.8%) were returned with the background/introduction section completed. Of these surveys 200 (94.3%) were completed by practicing pediatric urologists. Overall, 155 respondents (77.5%) reported performing 5 or fewer oncology related surgeries per year and 74.9% reported that less than 25% of renal tumor surgery at their institution was performed through the pediatric urology service. On multivariate analysis the self-reported factors significantly associated with increased oncology surgical volume (more than 5 cases per year) were greater than 50% attendance at institutional tumor board meetings (OR 4.8, 95% CI 1.4-16.9) and practicing at a hospital with a higher volume of renal tumor surgery (OR 2.6, 95% CI 1.2-5.8). Few surveyed pediatric urologists reported performing a high volume of oncology surgery. Respondents expressed interest in ways to increase pediatric urology involvement in oncology care, including opportunities for increased education. Self-reported factors that correlated with higher volume were regular attendance at the institutional pediatric tumor board and practice at a higher volume institution.

Preoperative renal tumour embolisation revisited

Purpose: Renal artery embolisation prior to surgery for renal tumours has been used for a number of years, however, definitive evidence of its benefits remain elusive. As a result of continued development, the procedure now has minimal morbidity and a high technical success rate. Additionally, there is evidence that decreased immune surveillance as a consequence of blood transfusions is associated with cancer recurrence and progression. We studied the outcomes of the procedure in our institution.

Surgical protocol violations in children with renal tumors provides an opportunity to improve pediatric cancer care: a report from the Children's Oncology Group.

The purpose of this study was to evaluate the frequency and characteristics of surgical protocol violations (SPVs) among children undergoing surgery for renal tumors who were enrolled on the Children's Oncology Group (COG) renal tumor biology and classification study AREN03B2. AREN03B2 was opened in February 2006, and as on March 31, 2013, there were 3,664 eligible patients. The surgical review forms for 3,536 patients with unilateral disease were centrally reviewed for SPVs. The frequency, type, number of violations, institutional prevalence, and quartiles for SPVs were assessed. Of the 3,536 patients, there were a total of 505 with at least one SPV (564 total SPVs reported), for an overall incidence of 14.28%. The types of SPVs included a lack of lymph node sampling in 365 (64.7%), avoidable spill in 61 (10.8%), biopsy immediately before nephrectomy in 89 (15.8%), an incorrect abdominal incision in 32 (5.7%), and unnecessary resection of organs in 17 (3.0%). The SPVs occurred in 163 of 215 participating institutions (75.8%). For centers with at least one SPV, the mean number of SPVs reported was 3.10 ± 2.39 (mean ± standard deviation). The incidence of protocol violation per institution ranged from 0 to 67%. Centers with an average of ≤1 case/year had an incidence of SPVs of 12.2 ± 3.8%, those with an average of >1 to <4 cases/year had an incidence of SPVs of 16.4 ± 3.6%, and those with an average of ≥4 cases/year had an incidence of SPVs of 12.6 ± 5.5% (P > 0.05). SPVs that potentially result in additional exposure to chemotherapy and radiation therapy are not uncommon in children undergoing resection of renal malignancies.

Do programmed death 1 (PD-1) and its ligand (PD-L1) play a role in patients with non-clear cell renal cell carcinoma?

Clinical trials targeting programmed death 1 (PD-1) and its ligand PD-L1 (PD-L1) for metastatic renal cell cancer (RCC) are ongoing. The aim of this study is to validate their roles as prognostic markers in non-clear cell (non-cc) RCC. Sixty-four non-cc RCC tissue specimens were collected from patients undergoing renal tumor surgery. Expressions of biomarkers were assessed using immunohistochemistry and compared with clinical characteristics. Survival analyses were performed with a median follow-up of 77.5 (range: 0-176) months. No significant correlations were found for PD-1(+) tumor-infiltrating mononuclear cells (TIMC) or PD-L1(+) expression and clinical attributes in patients with non-cc RCC. Kaplan-Meier analysis revealed no differences in 5- and 10-year cancer-specific survival (CSS) for PD-1(-) TIMC compared to PD-1(+) TIMC (71.4 and 63% versus 72.2 and 61.9%; p=0.88). Intratumoral expression of PD-L1 did not appear to influence the 5- and 10-year CSS significantly, even though a trend was identified (68 and 53.6% versus 80.1 and 75.7%; p=0.08). In multivariate analysis, neither PD-1(+) TIMC nor intratumoral PD-L1(+) expression proved to be independent predictors of CSS (p=0.99 and p=0.68, respectively). Our study demonstrates that PD-1(+) TIMC and intratumoral PD-L1(+) expression did not significantly impact tumor aggressiveness or clinical outcome in non-ccRCC specimens. Due to rare incidence of non-cc RCC in particular according to PD-L1 expression, further analyzes are warranted.

AB145. The investigation of the clinical safety and oncologic outcomes between retroperitoneoscopic and open radical nephrectomy (tumor size &gt;7 cm)

ObjectiveTo compare the clinical safety of laparoscopic (LRN) and open radical nephrectomy (ORN) surgery for large renal tumors (>7 cm).MethodsThe clinical data of the 80 patients with renal tumors more than 7 cm who underwent radical nephrectomy during June 2010 to march 2014 were collected and analyzed. LRN (observation group) were performed in 29 patients, and ORN (control group) were performed in the other 51 patients, Compared the clinical safety and outcomes of surgery between the two groups.ResultsOverall, 29 patients underwent LRN in the study period. The mean tumor size was 8.5 cm (range, 7.0–15.6 cm). The mean operation time was 105 min (range, 70–190 min). The mean blood loss was 300 mL, while four patients (13.8%) received blood transfusion, and two Patients were converted to open surgery. In the operative blood loss, postoperative drainage time, postoperative hospital stay, postoperative recovery time of intestinal were better than that of control group, The operation time was longer than the control group. Postoperative follow-up was 3–45 months.ConclusionsThe retroperitoneal laparoscopic radical nephrectomy of renal cell carcinoma is a safe and effective therapy, and provides the oncologic outcomes equivalent to those of ORN.

PD29-01 LONG TERM RENAL FUNCTION AFTER PARTIAL NEPHRECTOMY VS RADICAL NEPHRECTOMY IN PATIENTS WITH PREEXISTING CHRONIC KIDNEY DISEASE: A PROPENSITY SCORE-MATCHED ANALYSIS

INTRODUCTION AND OBJECTIVES: Partial nephrectomy (PN) is recommended as the standard of care for small renal masses (SRM) based on the lower risk of chronic kidney disease (CKD) and comparable oncological outcomes with Radical Nephrectomy (RN). It is estimated that 25-30% of the patients undergoing surgery for renal tumors have pre-existing CKD. Among these patients, renal preservation through a nephron-sparing approach is paramount. Nonetheless, to date, data on whether residual renal function is adequately preserved in patients with preexisting CKD after PN, remains to be determined. We sought to determine the progression of baseline CKD after PN compared with those who underwent RN. METHODS: After IRB approval the institutional kidney cancer database was queried for patients who underwent RN or PN with baseline CKD (estimated glomerular filtration rate (eGFR) <60 ml/ min per 1.73m2) between 2003 and 2012. A total of 305 patients who underwent RN and 274 patients who underwent PN with baseline CKD were identified. Propensity scoring was performed considering the following variables: age, race, Charlson Comorbidity Index and presence of a solitary kidney. After propensity scorematching, survival and functional outcomes of 221 patients who underwent PN were compared against 221 patients who underwent RN. RESULTS: Patients were classified into three groups according to the preoperative eGFR: Those with eGFR of 45-59 ml/ min/1.73 m2 (67.2%); with eGFR of 30-44 ml/min/1.732 (24.4%) and eGFR <30 ml/min/1.73 m2 (8.3%). Median follow up time was 53.5 months. Among the first two groups, the probability of freedom from new onset of eGFR <30 ml/min/1.73 m2 was significantly different between the PN and RN groups (PN: 2 years 79%, 5 years 75%; RN 2 years 64%, 5 years 62%; p <0.001). Similarly, among the first group the probability of freedom from new onset of eGFR <45 ml/ min/1.73 m2 was significantly different between PN vs RN groups (PN: 2 years 48%, 5 years 46%; RN 2 years 14%, 5 years 11%; p <0.001). Nonetheless, there was no significant difference in the need for dialysis in patients who underwent RN vs PN with a baseline eGFR above 30 ml/min/1.732 (p1⁄40.69). Lastly, patients who underwent PN had significantly longer overall survival (OS) compared to RN (Median OS: PN not reached, RN 72.6 months, p <0.001). CONCLUSIONS: PN can successfully avert the development of end-stage renal disease or eGFR <30 ml/min/1.73 m2 in patients with baseline CKD of eGFR at 30-60 ml/min /1.73 m2. Where feasible, nephron-sparing surgery should be considered for these patients.

151 Antibiotic prophylaxis is avoidable in minimally invasive clean surgery for renal or adrenal tumors: A prospective study of 678 cases

151 Antibiotic prophylaxis is avoidable in minimally invasive clean surgery for renal or adrenal tumors: A prospective study of 678 cases

LAPAROSCOPIC RADICAL NEPHRECTOMY FOR RENAL TUMOR>7CM.

(Objectives) Laparoscopic radical nephrectomy (LRN) is now a standard care for the treatment of renal tumors, but the limitation of LRN for large tumors remains to be elucidated. In this study, we examined the safety and efficacy of LRN for >7 cm renal tumors including tumors >10 cm. (Patients and methods) From March 2001 to September 2014, 167 patients received laparoscopic surgery for renal tumors at our institution. Of these, 126 patients (≤4.0 cm: 64 cases, 4.1-7.0 cm: 40 cases, 7.1-10.0 cm: 12 cases, >10.0 cm: 10 cases) underwent LRN. Treatment outcomes including surgical and oncological outcomes among each stage were compared. (Results) Operating time for 7.1-10.0 cm tumors were similar to that <7 cm tumors but that for >10 cm tumors was significantly longer than that <10 cm tumors. There was no significant difference among each stage in terms of complication rate. As expected, recurrence-free survival rate for >10 cm tumors were worse than <10 cm tumors. (Conclusions) Our data suggests that LRN for large tumors >7 cm can be performed safely, but LRN for >10 cm tumors are technically demanding and require longer operation time.