MP37-08 OUTCOMES OF ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR CLINICAL T3A RENAL MASS: ANALYSIS OF THE ROBOTIC SURGERY FOR LARGE RENAL MASS (ROSULA) GROUP (2019)

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (MP37)1 Apr 2019MP37-08 OUTCOMES OF ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR CLINICAL T3A RENAL MASS: ANALYSIS OF THE ROBOTIC SURGERY FOR LARGE RENAL MASS (ROSULA) GROUP Ahmet Bindayi*, Akbar Ashrafi, Koon Rha, Sisto Perdona, Giuseppe Simone, Chandru Sundaram, Andrea Minervini, Andrea Mari, Benjamin Challacombe, Prokar Dasgupta, Stephen Ryan, Madhumitha Reddy, Uzoma Anele, Giuseppe Quarto, Francesco Porpiglia, Michele Gallucci, Inderbir Gill, Riccardo Autorino, Monish Aron, and Ithaar Derweesh Ahmet Bindayi*Ahmet Bindayi* More articles by this author , Akbar AshrafiAkbar Ashrafi More articles by this author , Koon RhaKoon Rha More articles by this author , Sisto PerdonaSisto Perdona More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Chandru SundaramChandru Sundaram More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Andrea MariAndrea Mari More articles by this author , Benjamin ChallacombeBenjamin Challacombe More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , Stephen RyanStephen Ryan More articles by this author , Madhumitha ReddyMadhumitha Reddy More articles by this author , Uzoma AneleUzoma Anele More articles by this author , Giuseppe QuartoGiuseppe Quarto More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Michele GallucciMichele Gallucci More articles by this author , Inderbir GillInderbir Gill More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Monish AronMonish Aron More articles by this author , and Ithaar DerweeshIthaar Derweesh More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556038.33688.4bAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Use of partial nephrectomy for clinical T3a renal mass (cT3aRM) is controversial. We sought to evaluate the quality outcomes of robot-assisted partial nephrectomy (RAPN). METHODS: Retrospective multicenter and multinational analysis of patients with nonmetastatic cT3a renal mass [RObotic SUrgery for LArge renal mass (ROSULA) Group]. Patient demographics, tumor characteristics, perioperative variables, renal functional data and pathological outcomes were analyzed. Primary endpoint was Trifecta, a composite quality outcome defined as negative surgical margin, warm ischemia time (WIT) ≤25 min, and no perioperative complications. “Optimal outcome” was define as achievement of Trifecta and ≥90% estimated glomerular filtration rate (eGFR) preservation and no chronic kidney disease (CKD) stage upgrading. Multivariable analysis (MVA) was used to identify risk factors associated lack of ‘optimal outcome’ achievement. RESULTS: A total of 100 patients with median age 60 [IQR: 56-69], median follow-up 16.8 [IQR 9-24.8] months were analyzed. Median tumor size and RENAL score were 7.7 [IQR: 6.6-8.2] cm and 9 [IQR: 9-10], respectively. In total, 24/100 (24%) patients underwent RAPN for imperative indications. Median operative time, blood loss and WIT were 200 [157-235] minutes, 300 [155-534] mL and 20 [15-21] minutes, respectively; 94 (94%) had negative margins. Intra- and postoperative complications were noted in 11 (11%) patients for each category, while 8 (8%) had major (Clavien-Dindo grade 3-5) complications. Median ΔeGFR was 8 ml/min/1.72m2, with ≥90% eGFR preservation noted in 52%. Trifecta rate was 64% and 41% achieved optimal outcome. MVA for factors associated with failure to achieve optimal outcome revealed increasing RENAL nephrometry score (OR 1.19, p=0.027), decreasing preoperative eGFR (OR 1.16, p=0.002), and increasing estimated blood loss (OR 1.05, p=0.038) as independent risk factors (Table). CONCLUSIONS: RAPN for select cT3aRM is feasible and safe, with acceptable quality outcomes. Further investigation is requisite to delineate role in management of cT3a disease. Source of Funding: “none” San Diego, CA; Los Angeles, CA; Seoul, Korea, Republic of; Naples, Italy; Rome, Italy; Indianapolis, IN; Firenze, Italy; London, United Kingdom; San Diego, CA; Richmond, VA; Naples, Italy; Orbassano, Italy; Rome, Italy; Los Angeles, CA; Richmond, VA; Los Angeles, CA; San Diego, CA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e526-e526 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmet Bindayi* More articles by this author Akbar Ashrafi More articles by this author Koon Rha More articles by this author Sisto Perdona More articles by this author Giuseppe Simone More articles by this author Chandru Sundaram More articles by this author Andrea Minervini More articles by this author Andrea Mari More articles by this author Benjamin Challacombe More articles by this author Prokar Dasgupta More articles by this author Stephen Ryan More articles by this author Madhumitha Reddy More articles by this author Uzoma Anele More articles by this author Giuseppe Quarto More articles by this author Francesco Porpiglia More articles by this author Michele Gallucci More articles by this author Inderbir Gill More articles by this author Riccardo Autorino More articles by this author Monish Aron More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...