PD41-05 PROPENSITY SCORE MATCHED COMPARISON OF MINIMALLY INVASIVE PARTIAL AND RADICAL NEPHRECTOMY FOR CLINICAL T2A RENAL MASS: ANALYSIS OF THE ROBOTIC SURGERY FOR LARGE RENAL MASSES (ROSULA) GROUP (2019)

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV (PD41)1 Apr 2019PD41-05 PROPENSITY SCORE MATCHED COMPARISON OF MINIMALLY INVASIVE PARTIAL AND RADICAL NEPHRECTOMY FOR CLINICAL T2A RENAL MASS: ANALYSIS OF THE ROBOTIC SURGERY FOR LARGE RENAL MASSES (ROSULA) GROUP Aaron Bradshaw*, Riccardo Autorino, Giuseppe Simone, Chao Zang, Riccardo Bertolo, Juan Garisto, Robert Uzzo, Umberto Capitanio, James Porter, Andrea Minervini, Daniel Eun, Clayton Lau, Patrick Kilday, Koon H. Rha, Alexander Mottrie, Wesley M. White, Luigi Schips, Kenneth Jacobsohn, Ben Challacombe, Matteo Ferro, Uzoma A. Anele, Gabriele Tuderti, Stephen Ryan, Ahmet Bindayi, Andrea Mari, Aryeh Keehn, Michael Liao, Alessandro Larcher, Geert de Naeyer, Peter Langenstroer, Alexander Kutikov, Francesco Montorsi, Georges-Pascal Haber, Lance J. Hampton, Michele Gallucci, Bo Yang, Chandru Sundaram, Carmen M. Mir, Akbar Ashrafi, Francesco Porpiglia, Jihad Kaouk, Monish Aron, and Ithaar Derweesh Aaron Bradshaw*Aaron Bradshaw* More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Giuseppe SimoneGiuseppe Simone More articles by this author , Chao ZangChao Zang More articles by this author , Riccardo BertoloRiccardo Bertolo More articles by this author , Juan GaristoJuan Garisto More articles by this author , Robert UzzoRobert Uzzo More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , James PorterJames Porter More articles by this author , Andrea MinerviniAndrea Minervini More articles by this author , Daniel EunDaniel Eun More articles by this author , Clayton LauClayton Lau More articles by this author , Patrick KildayPatrick Kilday More articles by this author , Koon H. RhaKoon H. Rha More articles by this author , Alexander MottrieAlexander Mottrie More articles by this author , Wesley M. WhiteWesley M. White More articles by this author , Luigi SchipsLuigi Schips More articles by this author , Kenneth JacobsohnKenneth Jacobsohn More articles by this author , Ben ChallacombeBen Challacombe More articles by this author , Matteo FerroMatteo Ferro More articles by this author , Uzoma A. AneleUzoma A. Anele More articles by this author , Gabriele TudertiGabriele Tuderti More articles by this author , Stephen RyanStephen Ryan More articles by this author , Ahmet BindayiAhmet Bindayi More articles by this author , Andrea MariAndrea Mari More articles by this author , Aryeh KeehnAryeh Keehn More articles by this author , Michael LiaoMichael Liao More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Geert de NaeyerGeert de Naeyer More articles by this author , Peter LangenstroerPeter Langenstroer More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , Lance J. HamptonLance J. Hampton More articles by this author , Michele GallucciMichele Gallucci More articles by this author , Bo YangBo Yang More articles by this author , Chandru SundaramChandru Sundaram More articles by this author , Carmen M. MirCarmen M. Mir More articles by this author , Akbar AshrafiAkbar Ashrafi More articles by this author , Francesco PorpigliaFrancesco Porpiglia More articles by this author , Jihad KaoukJihad Kaouk 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.0000556549.16599.45AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: While emerging data suggest feasibility and safety of minimally invasive partial nephrectomy (MIS-PN) for T2a renal mass (T2aRM), comparative analyses to minimally invasive radical nephrectomy (MIS-RN) are limited. We conducted a propensity score-matched comparison of outcomes of MIS-RN and PN in clinical T2a renal mass utilizing a large multicenter registry. METHODS: Retrospective multicenter analysis of MIS-PN and RN for cT2aRM (T2aN0M0) [RObotic SUrgery for LArge renal mass (ROSULA) Group]. Cohorts were propensity matched for age, sex, BMI and clinical tumor size using a 2:1 ratio for RN:PN. Primary outcome was disease-free survival (DFS), with secondary outcomes of overall survival (OS), change in estimated glomerular filtration rate (ΔeGFR), de novo eGFR<60 mL/min/1.73m2 and eGFR<45. Cox Regression (MVA) and Kaplan-Meier analyses (KMA) were carried out for outcomes. RESULTS: 648 patients (216 PN/432 RN, median follow up 18 months) were matched. There was no significant difference in age (p=0.302), sex (p=0.505), BMI (p=0.221), or tumor size (RN 8.16 vs. PN 8.06 cm, p=0.10). No differences were noted in Clavien 3/4 complications (p=0.062) and readmissions (p=0.139). PN had lower ΔeGFR (9.4 vs. 24.4, p<0.001), de novo eGFR <60 (p<0.001) and de novo eGFR<45 (4.0% vs. 18.8%, p<0.001). MVA revealed increasing ASA score (HR 2.7, p=0.044) and sarcomatoid histology (HR 5.3, p=0.001), but not surgery type (p=0.601) to be associated with worsened all-cause mortality. Pathologic upstaging (HR 2.5, p=0.010), high tumor grade (HR 2.7, p=0.016), and sarcomatoid histology (HR 2.4, p=0.033) were associated with recurrence, while surgery type (p=0.550) was not. Increasing age (HR 1.1, p<0.001) and RN (HR 4.6, p =0.001) were predictors for de novo eGFR<45. KMA showed 77.8% and 79.4% 5-year DFS for patients undergoing MIS-PN and RN, respectively (Figure 1; p=0.410), and 77.1% and 88.2% 5-year OS for patients who underwent MIS-PN and RN, respectively (p=0.280). CONCLUSIONS: In a propensity matched cT2a cohort, MIS-PN demonstrated similar oncologic outcomes while conferring functional benefit. When feasible, MIS-PN may be considered as a viable option for select cT2a renal masses. Source of Funding: None San Diego, CA; Richmond, VA; Rome, Italy; Shanghai, China, People’s Republic of; Cleveland, OH; Philadelphia, PA; Milan, Italy; Seattle, WA; Florence, Italy; Philadelphia, PA; Los Angeles, CA; Seoul, Korea, Republic of; Aalst, Belgium; Knoxville, TN; Chieti and Pescara, Italy; Milwaukee, WI; London, United Kingdom; Milan, Italy; Richmond, VA; Rome, Italy; San Diego, CA; Florence, Italy; Philadelphia, PA; Seattle, WA; Milan, Italy; Aalst, Belgium; Milwaukee, WI; Philadelphia, PA; Milan, Italy; Cleveland, OH; Richmond, VA; Rome, Italy; Shanghai, China, People’s Republic of; Indiannapolis, IN; Valencia, Spain; Los Angeles, CA; Turin, Italy; Cleveland, OH; Los Angeles, CA; San Diego, CA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e746-e746 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Bradshaw* More articles by this author Riccardo Autorino More articles by this author Giuseppe Simone More articles by this author Chao Zang More articles by this author Riccardo Bertolo More articles by this author Juan Garisto More articles by this author Robert Uzzo More articles by this author Umberto Capitanio More articles by this author James Porter More articles by this author Andrea Minervini More articles by this author Daniel Eun More articles by this author Clayton Lau More articles by this author Patrick Kilday More articles by this author Koon H. Rha More articles by this author Alexander Mottrie More articles by this author Wesley M. White More articles by this author Luigi Schips More articles by this author Kenneth Jacobsohn More articles by this author Ben Challacombe More articles by this author Matteo Ferro More articles by this author Uzoma A. Anele More articles by this author Gabriele Tuderti More articles by this author Stephen Ryan More articles by this author Ahmet Bindayi More articles by this author Andrea Mari More articles by this author Aryeh Keehn More articles by this author Michael Liao More articles by this author Alessandro Larcher More articles by this author Geert de Naeyer More articles by this author Peter Langenstroer More articles by this author Alexander Kutikov More articles by this author Francesco Montorsi More articles by this author Georges-Pascal Haber More articles by this author Lance J. Hampton More articles by this author Michele Gallucci More articles by this author Bo Yang More articles by this author Chandru Sundaram More articles by this author Carmen M. Mir More articles by this author Akbar Ashrafi More articles by this author Francesco Porpiglia More articles by this author Jihad Kaouk More articles by this author Monish Aron More articles by this author Ithaar Derweesh More articles by this author Expand All Advertisement PDF downloadLoading ...