PD64-03 TREATMENT TRENDS FOR LARGE RENAL MASSES: 15-YEAR SINGLE INSTITUTIONAL EXPERIENCE

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy VI (PD64)1 Sep 2021PD64-03 TREATMENT TRENDS FOR LARGE RENAL MASSES: 15-YEAR SINGLE INSTITUTIONAL EXPERIENCE Dora Jericevic, Zachary Feuer, James Wysock, Samir Taneja, and William Huang Dora JericevicDora Jericevic More articles by this author , Zachary FeuerZachary Feuer More articles by this author , James WysockJames Wysock More articles by this author , Samir TanejaSamir Taneja More articles by this author , and William HuangWilliam Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002108.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The benefit of minimally invasive surgery (MIS: laparoscopic and robotic-assisted) for small renal masses has been established: decreased estimated blood loss (EBL), length of stay (LOS), operative (OR) time and complication rates with equivalent oncologic outcomes. For large renal masses (LRM), the benefits of MIS have not been as comprehensively described. Our study objectives were to assess temporal trends in the utilization of MIS versus open surgery for LRMs, and to describe pre and peri-operative differences between the 2 surgical approaches. METHODS: We identified patients who underwent radical nephrectomy (RN) for LRM (>7cm or clinical stage T2 or greater) between 2004-2021 in a prospectively maintained, IRB approved database of 1772 patients. The decision regarding surgical approach was at the discretion of the surgeon. Comparisons between the open and MIS approach were performed. RESULTS: We identified 193 patients undergoing surgery for a LRM. Demographic, tumor, surgical and perioperative characteristics are presented in Table 1. Surgeries performed using the open approach involved advanced (27% vs 6% ≥T3b) tumors, and were associated with higher EBLs, greater LOS and longer OR time (500 vs 100mL, 4 vs 2 days, 240 vs 167min, respectively), p<0.01 for each. Positive margin rates were comparable between groups. With increasing tumor size, there was decreasing utilization of MIS (figure 1). Over time, for advanced (≥T3b) LRM, there was a trend towards increasing use of MIS (29% in 2007 vs 71% in 2021). On nominal logistic regression analysis, the only statistically significant factors associated with use of the open approach were tumor size>10cm and advanced stage (≥T3b) were (odds ratio=6.4 and 5.6, respectively, p<0.01). CONCLUSIONS: Although very large and complex tumors are increasingly resected with MIS, open surgery continues to have an important role in the management of LRM, particularly for very large tumors and those with a higher clinical stage. Proper patient selection is imperative when selecting open vs MIS for LRM. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1144-e1144 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dora Jericevic More articles by this author Zachary Feuer More articles by this author James Wysock More articles by this author Samir Taneja More articles by this author William Huang More articles by this author Expand All Advertisement Loading ...