the risk of chronic kidney disease in the elderly after radical or partial ...

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Mahendra Bhandari, Detroit, MI; Alexandre Mottrie, Melle, Belgium;. Craig Rogers, Detroit, MI. INTRODUCTION AND OBJECTIVES: Partial nephrectomy can.
THE JOURNAL OF UROLOGYâ

Vol. 195, No. 4S, Supplement, Monday, May 9, 2016

e985

patients with CKD. Perioperative and functional outcomes 1 year after surgery appear acceptable, despite heterogeneity in surgical techniques, experience and patient population across multiple centers. Source of Funding: Vattikuti Foundation

MP75-17 THE RISK OF CHRONIC KIDNEY DISEASE IN THE ELDERLY AFTER RADICAL OR PARTIAL NEPHRECTOMY FOR MASSES LARGER THAN PT1A Lisly Chery*, Mehrad Adibi, Leonardo Borregales, Jessica Brandt, Devin Gu, Akshat Kumar, Surena Matin, Jose Karam, Christopher Wood, Houston, TX Source of Funding: none

MP75-16 OUTCOMES OF ROBOT-ASSISTED PARTIAL NEPHRECTOMY IN PATIENTS WITH COMPLEX RENAL TUMORS AND PRE-EXISTING CHRONIC KIDNEY DISEASE: A MULTI-INSTITUTIONAL ANALYSIS Deepansh Dalela*, Ravi Barod, Detroit, MI; Giorgio Gandaglia, Melle, Belgium; Ronney Abaza, Dublin, OH; Rajesh Ahlawat, Gurgaon, India; Nicolomaria Buffi, Rozzano, Italy; Ben Challacombe, Prokar Dasgupta, London, United Kingdom; Daniel Moon, Melbourne, Australia; Dipen Parekh, Miami, FL; Francesco Porpiglia, Orbassano, Italy; Sudhir Rawal, New Delhi, India; Giacomo Novara, Melle, Belgium; Mahendra Bhandari, Detroit, MI; Alexandre Mottrie, Melle, Belgium; Craig Rogers, Detroit, MI INTRODUCTION AND OBJECTIVES: Partial nephrectomy can help preserve renal function, but may be more challenging in patients with complex tumors. We compare outcomes of robot-assisted partial nephrectomy (RAPN) for complex tumors in patients with and without pre-existing chronic kidney disease (CKD). METHODS: Using the Vattikuti Collective Quality Initiative (VCQI) database (representing patients and surgeons from 11 centers across 4 continents), we identified 250 patients undergoing RAPN for complex tumors (identified by RENAL or PADUA score of >10) between 2008-2013. Peri-operative (estimated blood loss [EBL], warm ischemia time [WIT], complications and positive surgical margins [PSM]) and functional outcomes (estimated glomerular filtration rate [eGFR] at 12-month follow-up) were assessed and stratified by preoperative CKD (CKD stage 3 or greater; n¼33, 13.2%) vs. no significant CKD (eGFR >60 ml/min/1.73 m2; n¼217, 86.8%). RESULTS: Overall, patients had a median (interquartile range) body mass index of 25.7 (23.3-28.9) kg/m2 and pre-operative eGFR of 83 (70-98) ml/min/1.73 m2 respectively. 48.4% tumors were >4 cm radius and 29.6% entirely endophytic. 95 (38%) tumors were posterior, 118 (47.2%) mid-polar and 67.2% had renal sinus involvement on preoperative imaging. Patients with CKD were older (median age 62 vs. 54; p¼0.001), had higher median age-adjusted Charlson comorbidity score (5.5 vs. 2; p¼Stage 3. CONCLUSIONS: Despite the surgical challenges, RAPN for patients with complex renal tumors is safe and feasible, even for

INTRODUCTION AND OBJECTIVES: The incidence of kidney cancer continues to rise, including patients 75 and older. This patient population presents a challenge as the benefits of preserved kidney function with a partial nephrectomy may be limited. The renal function outcomes after surgery in this patient population have not been well described. METHODS: Using a retrospective analysis of a prospectively maintained database, we examined patients  75 who underwent radical or partial nephrectomy for masses other than pT1a from 2001 to 2014. Patients had a solitary renal mass and normal contralateral kidney. The Modification of Diet in Renal Disease equation was used to estimate glomerular filtration rates before and after surgery. The Nation Kidney Foundation stages of chronic kidney disease [CKD] were used to categorize patients. RESULTS: Preoperative glomerular filtration rate [GFR] was similar between the radical nephrectomy [RN] group [n¼112, GFR ¼ 67.6 mL/min per 1.73 m2] and the partial nephrectomy [PN] group [n¼43, GFR ¼ 62.7]. Postoperative GFR was lower in the RN group [47.8 vs 54.7, p < 0.05]. Postoperatively, when compared to the PN group, the RN group had a higher rate of new onset CKD Stage 3 [45.5% vs 25.6%, p < 0.05]. The rate of new onset CKD Stage 4 [11.6% vs 9.3%, p ¼ 0.68] and CKD Stage 5 [2.7% vs 2.3%] were equal in the 2 groups. Clavien 3-5 complication rate in the RN group [6.3%] was not significantly different from the PN group [11.6%, p ¼ 0.26]. A sub analysis was performed on patients with preoperative GFR < 60 who had a RN [n¼38] or PN [n¼19]. Postoperative GFR was similar between the RN and PN groups [35.7 vs 42.5, respectively, p ¼ 0.08]. There was no difference in the onset of new CKD Stage 4 [28.9% vs 21.1%, respectively, p ¼ 0.53] or CKD Stage 5 [7.9% vs 5.3%, p ¼ 0.72]. CONCLUSIONS: For patients 75 years and older with renal masses bigger than pT1a, the use of radical nephrectomy was associated with a higher incidence of CKD Stage 3, and lower post-operative GFR when compared to partial nephrectomy. This effect was attenuated in patients with pre-existing CKD. The benefit of partial nephrectomy in this population may not outweigh the costs. Source of Funding: none

MP75-18 PARTIAL NEPHRECTOMY VERSUS RADICAL NEPHRECTOMY FOR CLINICAL T1B AND T2 RENAL MASS: A META-ANALYSIS OF OVER 9000 CASES Maria Carmen Mir*, Cleveland, OH; Ithaar Derweesh, , Please choose an option below; Francesco Porpiglia, Torino, Italy; Alessandro Volpe, Novara, Italy; Giacomo Novara, Padua, Italy; Vincenzo Ficarra, Udine, Italy; Nicola Pavan, Trieste, Italy; Humberto Laydner, Jihad Kaouk, Cleveland, OH; Homi Zargar, Melbourne, Australia; Riccardo Autorino, Cleveland, OH INTRODUCTION AND OBJECTIVES: Partial nephrectomy (PN) is the reference standard of management for cT1a (