Pd64-11 robotic partial nephrectomy vs. minimally invasive radical nephrectomy for clinical t3a renal mass: analysis from the rosula (robotic surgery for large renal mass) collaborative group

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy VI (PD64)1 Sep 2021PD64-11 ROBOTIC PARTIAL NEPHRECTOMY VS. MINIMALLY INVASIVE RADICAL NEPHRECTOMY FOR CLINICAL T3A RENAL MASS: ANALYSIS FROM THE ROSULA (ROBOTIC SURGERY FOR LARGE RENAL MASS) COLLABORATIVE GROUP Kendrick Yim, Riccardo Autorino, Devin Patel, Giuseppe Simone, Bo Yang, Robert Uzzo, Francesco Porpiglia, Umberto Capitanio, Jim Porter, Alp Beksac, Andrea Minervini, Clayton Lau, Kenneth Jacobsohn, Akbar Ashrafi, Daniel Eun, Alex Mottrie, Wesley White, Luigi Schips, Benjamin Challacombe, Ottavio De Cobelli, Maria Mir, Margaret Meagher, Joel Rosenberg, Sunil Patel, Umberto Carbonara, Alessandro Larcher, Alexander Kutikov, Monish Aaron, Prokar Dasgupta, Francesco Montorsi, Inderbir Gill, Chandru Sundaram, Jihad Kaouk, and Ithaar Derweesh Kendrick YimKendrick Yim More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Devin PatelDevin Patel More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Bo YangBo Yang More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Jim PorterJim Porter More articles by this author , Alp BeksacAlp Beksac More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Clayton LauClayton Lau More articles by this author , Kenneth JacobsohnKenneth Jacobsohn More articles by this author , Akbar AshrafiAkbar Ashrafi More articles by this author , Daniel EunDaniel Eun More articles by this author , Alex MottrieAlex Mottrie More articles by this author , Wesley WhiteWesley White More articles by this author , Luigi SchipsLuigi Schips More articles by this author , Benjamin ChallacombeBenjamin Challacombe More articles by this author , Ottavio De CobelliOttavio De Cobelli More articles by this author , Maria MirMaria Mir More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Joel RosenbergJoel Rosenberg More articles by this author , Sunil PatelSunil Patel More articles by this author , Umberto CarbonaraUmberto Carbonara More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Monish AaronMonish Aaron More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Inderbir GillInderbir Gill More articles by this author , Chandru SundaramChandru Sundaram More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002108.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Utilization of Partial nephrectomy (PN) in clinical T3a Renal Cell Carcinoma (cT3a RCC) is controversial. To date, no comparison with radical nephrectomy (RN) has been carried out. We compared survival and functional outcomes of robotic assisted PN (RAPN) and minimally invasive RN (MIS-RN) in cT3a RCC. METHODS: We performed retrospective analysis utilizing the ROSULA registry. Primary outcome was all cause mortality (ACM)/overall survival (OS). Secondary outcomes were cancer specific survival (CSS), recurrence/recurrence free survival (RFS), complications, and change in estimated glomerular filtration rate (DeGFR; mL/min/1.73m2). Multivariable Cox regression analysis (MVA) was used to elucidate predictors for survival and functional outcomes. Kaplan Meier Analysis (KMA) with was performed to assess oncological outcomes. RESULTS: 441 patients were analyzed (MIS-RN=246, RAPN=195; median follow up 18.0 months). MIS-RN had larger median clinical tumor size (7.4 vs. 6.5, p<0.01) and RENAL nephrometry score (10 vs. 9, p<0.01). No differences in overall (p=0.40) and major (Clavien 3/4) complications (p=0.40) complications were noted. Mean DeGFR 6 months postoperative was -19.8 for MIS-RN and -6.8 for RAPN (p<0.001). MVA demonstrated increasing ASA Class (HR 3.15, p=0.004), positive margins (HR 4.0; p=0.012), and sarcomatoid histology (HR 4.1, p=0.005) to be independently associated with worsened ACM, while type of surgery (p=0.205) was not. Increasing tumor size (HR 1.2, p=0.004), sarcomatoid (HR 3.97, p=0.005), and complications (HR 2.4, p=0.027) were independent risk factors for recurrence. Increasing age (HR 1.03, p=0.014, hypertension (HR 1.7, p=0.048) and RN (HR 2.96, p<0.001) were associated with de novo eGFR<60. For RAPN vs. MIS-RN, KMA revealed 5-year OS for 88.3% vs. 76.4%, (p=0.005); 5-year CSS of 92.3% vs. 88.1%, (p=0.108); and 5-year RFS for 79.1% vs. 55.0%, (p=0.095). CONCLUSIONS: In the setting of clinical T3a RCC, RAPN was not associated with worsened oncological outcomes and may provide functional benefit survival benefit when compared to MIS-RN. While RN remains the reference standard for cT3a disease, PN may be considered as an option when in select cases when clinically indicated and feasible. Source of Funding: Stephen Weissman Kidney Cancer Fund © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1149-e1150 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kendrick Yim More articles by this author Riccardo Autorino More articles by this author Devin Patel More articles by this author Giuseppe Simone More articles by this author Bo Yang More articles by this author Robert Uzzo More articles by this author Francesco Porpiglia More articles by this author Umberto Capitanio More articles by this author Jim Porter More articles by this author Alp Beksac More articles by this author Andrea Minervini More articles by this author Clayton Lau More articles by this author Kenneth Jacobsohn More articles by this author Akbar Ashrafi More articles by this author Daniel Eun More articles by this author Alex Mottrie More articles by this author Wesley White More articles by this author Luigi Schips More articles by this author Benjamin Challacombe More articles by this author Ottavio De Cobelli More articles by this author Maria Mir More articles by this author Margaret Meagher More articles by this author Joel Rosenberg More articles by this author Sunil Patel More articles by this author Umberto Carbonara More articles by this author Alessandro Larcher More articles by this author Alexander Kutikov More articles by this author Monish Aaron More articles by this author Prokar Dasgupta More articles by this author Francesco Montorsi More articles by this author Inderbir Gill More articles by this author Chandru Sundaram More articles by this author Jihad Kaouk More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement Loading ...