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28 PRELIMINARY ONCOLOGIC OUTCOME OF LAPAROSCOPIC ADRENALECTOMY FOR ISOLATED ADRENAL METASTASIS
e12
THE JOURNAL OF UROLOGY姞
Variable
Vol. 183, No. 4, Supplement, Saturday, May 29, 2010
N (%)
Gender Male
69 (75.8)
Female
22 (24.2)
RCC histologic subtype Clear Cell
80 (87.9)
Papillary
3 (3.3)
Sarcomatoid
7 (7.7)
Chromophobe
1 (1.1)
ence was registered in terms of perioperative and pathological variables; nevertheless, all cases of positive surgical margins (four cases) and conversions to open surgery (two cases) were recorded in group B. No significant difference was recorded in terms of disease specific survival time and OS.(p⬎0.05); CONCLUSIONS: LA for metastasis in patient with advanced LC seems to improve performance status of patients, whilst overall survival is still low. The safety of the procedure seems to be higher when the lesion size is ⬍ 5 cm. Source of Funding: None
Primary tumor stage T2
38 (42.8)
T3a
27 (29.7)
T3b/c
25 (27.5)
T4
1 (1.1)
28 PRELIMINARY ONCOLOGIC OUTCOME OF LAPAROSCOPIC ADRENALECTOMY FOR ISOLATED ADRENAL METASTASIS
Node Status Nx
21 (23.0)
N0
53 (58.2)
N1
6 (6.6)
N2
11 (12.1)
Metastatic Disease Status Mx/M0
69 (75.8)
M1
22 (24.1) TABLE 1: Clinicopathological demographics
Source of Funding: Kidney Cancer Keystone Program
27 LAPAROSCOPIC ADRENALECTOMY FOR ADRENAL METASTASIS OF LUNG CANCER: RESULTS OF A PROSPECTIVE STUDY Francesco Porpiglia*, Cristian Fiori, Riccardo Bertolo, Giovanni Selvaggi, Giorgio Scagliotti, Roberto Mario Scarpa, Orbassano (Torino), Italy INTRODUCTION AND OBJECTIVES: Aim of this prospective study is to evaluate the results of laparoscopic adrenalectomy (LA) for metachronous lung cancer metastasis in patients with advanced lung cancer (LC) treated with radio-chemotherapy. METHODS: From July 2002 to February 2009, patients affected by lung cancer (both Small Cell LC and Non Small Cell LC), previously treated with radio-chemotherapy in which metachronous solitary adrenal metastasis was demonstrated at follow up, were submitted to LA. In all cases LC was considered locally stable. The following parameters were registered: age, gender, side of lesion, pathology, size, operative time, blood loss, conversion, hospital stay, complications, pre- and 1 month post-operative Karnofsky Performance Status Score (KPSS) and oncological outcomes. Moreover, in order to better define the safety of the procedure, patients were stratified according to lesion size (⬎5 cm Group A vs ⬍5 cm Group B) and the two subgroups were compared using the same variables. Statistical analyses were performed using Kaplan-Meyer method, Student t test and chi square test, a p-value ⬎ 0.05 was considered significant RESULTS: Twenty-seven patients were enrolled in this study: median age was 62.3 (40-79), median lesions size was 5.1 (1.2-13.0), operative time was 120.0 minutes (75.0-180), blood losses were 247.4 cc (50.0-400.0). Two conversions to open surgery were recorded due to infiltration of surrounding tissue; hospital stay was 4.1 (3.0-5.0) days, preoperative and postoperative KPSS was 56.8 and 63.1 respectively (p⬍0.05). Pathological analyses revealed a LC metastases in all cases, whilst in 4 cases (14.5%) positive surgical margins was registered. Eighteen patients died (66.6%), 16 due to systemic progression and cachexy, one for acute embolism and one for local recurrence. Median follow-up was 10.2 months whilst median overall survival (OS) was 9 months. A comparison between subgroups B was performed: 17 and 10 patients were assigned to subgroup A and B respectively: median size was 3.3 and 8.4 cm respectively (p⬍0.0001). No statistical differ-
Rocco Papalia*, Giuseppe Simone, Salvatore Guaglianone, Alfredo Bove, Ester Forastiere, Michele Gallucci, Rome, Italy INTRODUCTION AND OBJECTIVES: We report the oncological outcome of laparoscopic treatment of adrenal metastases. METHODS: Between October 2002 and May 2009 128 laparoscopic adrenalectomies (LA) were performed. We retrospectively reviewed a prospectively maintained database to evaluate the outcome of 16 patients undergone LA for adrenal metastasis. Preoperative data, perioperative results and follow-up were evaluated. RESULTS: Nineteen LAs were performed in 16 patients. The mean operative time was 48 minutes (range 35-63) for unilateral procedures and 115 minutes (range 75 to 160) for single setting bilateral procedures. The mean blood loss was 60 ml (range 30-150ml) for unilateral adrenalectomies and 80 ml (50-300ml) for bilateral ones. No major complication occurred. The median time to discharge was 3 days (range 2 to 6). The median tumor size was 5,5 cm (range 3.5 to 10). The pathologic analysis revealed renal cell carcinoma metastases in 10 patients and transitional cell carcinoma metastases in two men who underwent bilateral laparoscopic adrenalectomy. Metastasis from papillary renal cell carcinoma, poorly differentiate lung carcinoma, colorectal carcinoma and melanoma were respectively detected in the other four patients. Surgical margins were negative in all patients and local recurrence occurred in one patient. At a median follow-up of 21 months 75% of patients were alive and 31,25% were disease free. The mean time to recurrence was 13 months (range 4-50). When analyzed for primary tumor histology, recurrence free survival rate in the group of patients with renal cell carcinoma metastasis was 46% and cancer specific survival rate was 91%. No patients with primary tumor histology different by renal cell carcinoma was recurrence free and 4 out of 5 five patients died of disease. CONCLUSIONS: Laparoscopic removal of adrenal metastasis is minimally invasive and oncologically effective. The final outcome of patients mainly depends on the primary tumor histology and on the chances of treatment of metastases subsequently developed. Source of Funding: None
29 DETERMINATION OF THE BEST BIOCHEMICAL EVALUATION FOR THE DIAGNOSIS OF PHEOCHROMOCYTOMA Eric Huyghe*, Ali Salloum, Julien Berbe, Boris Delaunay, Antoine Bennet, Philippe Caron, Michel Soulie, Pierre Plante, Toulouse, France INTRODUCTION AND OBJECTIVES: To compare the performances of the various combinations of urinary biochemical dosages used for the diagnosis of pheochromcytoma. METHODS: One center cohort study of patients tested for suspicion of pheochromocytoma between 1998 and 2007. The analysis included 51 patients in whom we had at least one preoperative urine dosage of catecholamines and their metabolites prior to surgery. We divided the population into 2 groups, group 1 (n⫽38) with patients who had histopathological confirmation of pheochromocytoma and group 2
THE JOURNAL OF UROLOGY姞
Variable
Vol. 183, No. 4, Supplement, Saturday, May 29, 2010
N (%)
Gender Male
69 (75.8)
Female
22 (24.2)
RCC histologic subtype Clear Cell
80 (87.9)
Papillary
3 (3.3)
Sarcomatoid
7 (7.7)
Chromophobe
1 (1.1)
ence was registered in terms of perioperative and pathological variables; nevertheless, all cases of positive surgical margins (four cases) and conversions to open surgery (two cases) were recorded in group B. No significant difference was recorded in terms of disease specific survival time and OS.(p⬎0.05); CONCLUSIONS: LA for metastasis in patient with advanced LC seems to improve performance status of patients, whilst overall survival is still low. The safety of the procedure seems to be higher when the lesion size is ⬍ 5 cm. Source of Funding: None
Primary tumor stage T2
38 (42.8)
T3a
27 (29.7)
T3b/c
25 (27.5)
T4
1 (1.1)
28 PRELIMINARY ONCOLOGIC OUTCOME OF LAPAROSCOPIC ADRENALECTOMY FOR ISOLATED ADRENAL METASTASIS
Node Status Nx
21 (23.0)
N0
53 (58.2)
N1
6 (6.6)
N2
11 (12.1)
Metastatic Disease Status Mx/M0
69 (75.8)
M1
22 (24.1) TABLE 1: Clinicopathological demographics
Source of Funding: Kidney Cancer Keystone Program
27 LAPAROSCOPIC ADRENALECTOMY FOR ADRENAL METASTASIS OF LUNG CANCER: RESULTS OF A PROSPECTIVE STUDY Francesco Porpiglia*, Cristian Fiori, Riccardo Bertolo, Giovanni Selvaggi, Giorgio Scagliotti, Roberto Mario Scarpa, Orbassano (Torino), Italy INTRODUCTION AND OBJECTIVES: Aim of this prospective study is to evaluate the results of laparoscopic adrenalectomy (LA) for metachronous lung cancer metastasis in patients with advanced lung cancer (LC) treated with radio-chemotherapy. METHODS: From July 2002 to February 2009, patients affected by lung cancer (both Small Cell LC and Non Small Cell LC), previously treated with radio-chemotherapy in which metachronous solitary adrenal metastasis was demonstrated at follow up, were submitted to LA. In all cases LC was considered locally stable. The following parameters were registered: age, gender, side of lesion, pathology, size, operative time, blood loss, conversion, hospital stay, complications, pre- and 1 month post-operative Karnofsky Performance Status Score (KPSS) and oncological outcomes. Moreover, in order to better define the safety of the procedure, patients were stratified according to lesion size (⬎5 cm Group A vs ⬍5 cm Group B) and the two subgroups were compared using the same variables. Statistical analyses were performed using Kaplan-Meyer method, Student t test and chi square test, a p-value ⬎ 0.05 was considered significant RESULTS: Twenty-seven patients were enrolled in this study: median age was 62.3 (40-79), median lesions size was 5.1 (1.2-13.0), operative time was 120.0 minutes (75.0-180), blood losses were 247.4 cc (50.0-400.0). Two conversions to open surgery were recorded due to infiltration of surrounding tissue; hospital stay was 4.1 (3.0-5.0) days, preoperative and postoperative KPSS was 56.8 and 63.1 respectively (p⬍0.05). Pathological analyses revealed a LC metastases in all cases, whilst in 4 cases (14.5%) positive surgical margins was registered. Eighteen patients died (66.6%), 16 due to systemic progression and cachexy, one for acute embolism and one for local recurrence. Median follow-up was 10.2 months whilst median overall survival (OS) was 9 months. A comparison between subgroups B was performed: 17 and 10 patients were assigned to subgroup A and B respectively: median size was 3.3 and 8.4 cm respectively (p⬍0.0001). No statistical differ-
Rocco Papalia*, Giuseppe Simone, Salvatore Guaglianone, Alfredo Bove, Ester Forastiere, Michele Gallucci, Rome, Italy INTRODUCTION AND OBJECTIVES: We report the oncological outcome of laparoscopic treatment of adrenal metastases. METHODS: Between October 2002 and May 2009 128 laparoscopic adrenalectomies (LA) were performed. We retrospectively reviewed a prospectively maintained database to evaluate the outcome of 16 patients undergone LA for adrenal metastasis. Preoperative data, perioperative results and follow-up were evaluated. RESULTS: Nineteen LAs were performed in 16 patients. The mean operative time was 48 minutes (range 35-63) for unilateral procedures and 115 minutes (range 75 to 160) for single setting bilateral procedures. The mean blood loss was 60 ml (range 30-150ml) for unilateral adrenalectomies and 80 ml (50-300ml) for bilateral ones. No major complication occurred. The median time to discharge was 3 days (range 2 to 6). The median tumor size was 5,5 cm (range 3.5 to 10). The pathologic analysis revealed renal cell carcinoma metastases in 10 patients and transitional cell carcinoma metastases in two men who underwent bilateral laparoscopic adrenalectomy. Metastasis from papillary renal cell carcinoma, poorly differentiate lung carcinoma, colorectal carcinoma and melanoma were respectively detected in the other four patients. Surgical margins were negative in all patients and local recurrence occurred in one patient. At a median follow-up of 21 months 75% of patients were alive and 31,25% were disease free. The mean time to recurrence was 13 months (range 4-50). When analyzed for primary tumor histology, recurrence free survival rate in the group of patients with renal cell carcinoma metastasis was 46% and cancer specific survival rate was 91%. No patients with primary tumor histology different by renal cell carcinoma was recurrence free and 4 out of 5 five patients died of disease. CONCLUSIONS: Laparoscopic removal of adrenal metastasis is minimally invasive and oncologically effective. The final outcome of patients mainly depends on the primary tumor histology and on the chances of treatment of metastases subsequently developed. Source of Funding: None
29 DETERMINATION OF THE BEST BIOCHEMICAL EVALUATION FOR THE DIAGNOSIS OF PHEOCHROMOCYTOMA Eric Huyghe*, Ali Salloum, Julien Berbe, Boris Delaunay, Antoine Bennet, Philippe Caron, Michel Soulie, Pierre Plante, Toulouse, France INTRODUCTION AND OBJECTIVES: To compare the performances of the various combinations of urinary biochemical dosages used for the diagnosis of pheochromcytoma. METHODS: One center cohort study of patients tested for suspicion of pheochromocytoma between 1998 and 2007. The analysis included 51 patients in whom we had at least one preoperative urine dosage of catecholamines and their metabolites prior to surgery. We divided the population into 2 groups, group 1 (n⫽38) with patients who had histopathological confirmation of pheochromocytoma and group 2