- Email: [email protected]
MP57-13 LAPAROSCOPIC VERSUS PERCUTANEOUS CRYOABLATION FOR T1 RENAL MASSES: AN ITALIAN MULTICENTRIC STUDY
THE JOURNAL OF UROLOGYâ
e694
and one for which there is limited published outcomes and guidelines. We investigated outcomes of this nephron sparing approach for local surgical excision of LG UTUC with large tumor burden >1.5cm using percutaneous endoscopic resection. METHODS: A retrospective analysis of all cases by a single surgeon in an academic center over a five-year period (2009-2014) was performed. We identified 29 patients with upper tract urothelial neoplasms >1.5cm having undergone percutaneous resection as primary treatment. Demographic and statistical analysis of patient variables as well as surgical and pathological outcomes was undertaken. Of the 29 total, 9 women and 20 men with a mean age of 63.6 (47-76) underwent percutaneous resection (right 16 / left 13). Surgical access was achieved by the surgeon. Resection was performed through a 34 Fr renal sheath using a 26 Fr nephroscope and 3mm extended length laparoscopic instruments or 26 Fr extended length resectoscope. RESULTS: One patient who underwent resection of 10 cm LG tumor had a complicated post-operative course necessitating completion radical nephroureterectomy (RNU) on post-operative day nine due to renal infarction. Final renal pathology demonstrated no residual tumor. Of the remaining 28 patients in this series, 21 (72.4%) were confirmed to have LG UTUC on final pathology, two patients (6.9%) were upstaged with HG UTUC on final pathology necessitating completion RNU, and five patients (17.2%) had LMP. Mean tumor size was 2.8 cm (1.5cm - 10cm). Mean follow-up duration was 22.7 months (9 mo - 65 mo). During this observation period, recurrences were found in 5/17 (29.4%) LG UTUC patients, and 0/5 LMP patients. All recurrences were LG and treated with ureteroscopic laser ablation. Tract tumor seeding not observed. CONCLUSIONS: Low risk UTUC can be effectively managed with percutaneous endoscopic tumor resection. Patients that are found to have characteristics of HG UTUC may be best managed with completion RNU. Resection within the renal collecting system carries different risks and challenges that can be overcome with experience. Although larger studies and more data would be required to create guidelines for management of UTUC, percutaneous resection of larger LG tumors of the upper tract may be a safe and feasible option to aid in nephron preservation. Patients should be carefully selected and willing to undergo strict and lengthy follow up. Source of Funding: None
MP57-12 NO PROVEN BENEFIT OF POSTOPERATIVE DRAINAGE AFTER ROBOTIC PARTIAL NEPHRECTOMY Benoit Peyronnet*, Zineddine Khene, Rennes, France; Benjamin Pradere, Tours, France; Gregory Verhoest, Romain Mathieu, Rennes, France; Mathieu Roumiguie, Jean-Baptiste Beauval, Baumert, Paris, France; Toulouse, France; Christophe Vaessen, Herve phane Droupy, Nimes, France; Alexandre de la Taille, Cre teil, Ste France; Jean-Christophe Bernhard, Bordeaux, France; Nicolas Doumerc, Toulouse, France; Morgan Roupret, Paris, France; Karim Bensalah, Rennes, France INTRODUCTION AND OBJECTIVES: Despite little evidence in the literature, most surgeons leave a drain postoperatively after robotic partial nephrectomy (RPN). The aim of this study was to assess the impact of a post-operative drainage after RPN. METHODS: A retrospective multicentric study was conducted including all the RPN from 8 centers between 2009 and 2013. Two centers have stopped using postoperative drainage after a few dozen of cases. Preoperative characteristics, complication rates (according to Clavien score), the need for postoperative imaging or procedure (surgical or radiological) and length of hospital stay were compared between the groups postoperative drainage (D) and no postoperative drainage (ND) using c2 test for discrete variables and Mann-Whitney test for continuous variables.
Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
RESULTS: Among 521 RPN included, 105 were done without postoperative drainage (20 %). In the ND group, surgeons, surgeons were more experienced (> 50 procedures: 53% vs. 1%; p< 0,0001) but tumors were more complex (RENAL SCORE: 7,.5 vs. 6.4; p< 0.0001). Patients in both groups had similar complication rates (22.9% vs. 21.7%; p¼0.79) and major complication rates (Clavien 3: 9.5% vs. 9.6%; p¼0.38). The omission of postoperative drainage did not increase the risk of needing a CT scan (RR¼ 0.9; IC95%: 0.5-1.5). Conversely, length of hospital stay was shorter in the ND group (4.3 vs. 5.8 days; p¼ 0.0005). There were 6 urinary fistula, 4 in the D group (1%) and 2 in the ND group (1.9%; p¼0.42) but CT scan was needed to confim this diagnosis in each cases in both groups. Reoperation or radiological/ endoscopic procedures were needed in 100% of urinary fistula (none was cured only by the post-operative drain). CONCLUSIONS: The omission of postoperative drainage does not increase the risk of postoperative complication, CT scan or procedures. Conversely, it could increase length of stay. Postoperative drainage N¼416
no postoperative drainage N¼105
Complications
21.7%
22.9%
0.79
Major complications (Clavien grade > 2)
9.5%
9.6%
0.38
Postoperative CT-scan
13.3%
14.9%
0,68
5,8
4,3
0.0005*
Length of stay (days)
p-value
Source of Funding: none
MP57-13 LAPAROSCOPIC VERSUS PERCUTANEOUS CRYOABLATION FOR T1 RENAL MASSES: AN ITALIAN MULTICENTRIC STUDY Bernardino de Concilio*, Calogero Cicero, Dario del biondo, , Guglielmo Zeccolini, Bassano del Grappa, Italy; Fulvio Lagana Alessandro Pinzani, Dolo, Italy; Piero Pellegrini, Tiziano Stocca, Gorizia, Italy; Luca Balestreri, Martina Urbani, Aviano, Italy; Giovanni Carbognin, Negrar, Italy; Giuseppe Casarrubea, Fabio Zattoni, Padova, Italy; Davide Barbisan, Franco Merlo, Treviso, Italy; Salvatore Siracusano, Fulvio Stacul, Trieste, Italy; Antonio Celia, Bassano del Grappa, Italy INTRODUCTION AND OBJECTIVES: Detection of localized RCC has increased over the past 2 decades and both laparoscopic (LCA) and percutaneous cryoablation (PCA) have demonstrated decreased morbidity with acceptable rates of oncologic success. The aim of our study was to evaluate the short and medium long term oncologic outcome of LCA and PCA of T1 renal tumors. METHODS: We performed an Italian multicentric prospective study of patients who underwent cryoablation (LCA or PCA) as their primary ablative treatment for cT1 solid renal masses. A total of 158 patients were identified: 22 undergoing LCA and 136 PCA. We used PADUA Score System for preoperative tumors classification. Follow-up included serial abdominal imaging (CT, MRI or CEUS), serum creatinine and eGFR. Recurrence-free survival (RFS) was defined by absence of evidence of local disease recurrence on followup imaging. RESULTS: Mean oncologic follow-up was 27.7 (21.6) months for LCA and 13.2 (11.8) for PCA. Kaplan-Meier estimated RFS curves for both groups demonstreated no difference (24-months RFS were 90% for LCA and 86% for PCA) even if stratified by biopsyproven RCC. A total of 8 patients experienced disease recurrence with no difference between the two groups. The treatment success rate is 90% (mean 28 months) for LCA and 95% (mean 13 months) for PCA. 133 biopsy were performed. Malignant features were demonstrated in the 86% in the LCA and 75% in the PCA group. Postoperative complications rate (Clavien-Dindo >1) was 13.6% in LCA and 2.2% in PCA groups. No patient required conversion to
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
open surgery. Only 1 patient in PCA group required a reintervention performed by radiological embolization. Both groups had a comparable mean postoperative serum creatinine and eGFR was stable over time in both groups. According to Clinical Practice Guideline for Acute Kidney Injury (AKI) only 5% of patients had an acute compromise renal function (AKI Stage 1) which resolved in a few days. At Univariate and Multivariate analysis predictors of Recurrence Disease (RD) included PADUA Score 8 (HR ¼ 9.99) and ASA risk 4 (HR ¼ 11.23). Limitations of our study are: limited follow-up, oncologic outcomes based only on radiographic criteria and lack of pathologic data in some cases. CONCLUSIONS: Our multicentric analysis shows that oncologic outcomes and complication rate in PCA treatment and LCA treatment have no statistical difference. Both treatments are safe and effective is the management of cT1 solid renal masses in patients who are poor candidates for conventional surgery. Longer follow-up is required to truly interpret oncologic outcomes after cryoablation. Source of Funding: none
MP57-14 INTRAOPERATIVE MOLECULAR DIAGNOSTIC IMAGING CAN IDENTIFY RENAL CELL CARCINOMA DURING NEPHRECTOMY Thomas Guzzo*, Jane Keating, Jack Jiang, Elizabeth DeJesus, Sunil Singhal, Philadelphia, PA INTRODUCTION AND OBJECTIVES: Clear cell histology is the most commonly diagnosed subtype of renal cell carcinoma (RCC) and accounts for the majority of renal cancer deaths. The most important prognostic indicator following surgery is a complete resection, however margin status can often be difficult to assess intraoperatively, particularly during partial nephrectomy given the time constraints related to renal hilar clamping. Thus, we hypothesized that a targeted molecular imaging approach could be used as an adjunct during surgery to identify the tumor margins and confirm disease clearance in the resection bed. METHODS: Multiple human tumors and murine RCC cell lines were tested for folate receptor alpha (FRa) expression by immunohistochemistry. A novel tracer targeting FRa (EC17) on RCC was tested on athymic mice (n¼50) bearing human renal carcinoma cell lines (RCC10, 786-0, UMRC2). Signal-to-background ratio (SBR) of the tumor to surrounding normal tissue was measured for each model. Based on these preclinical findings, we conducted a pilot study on 4 human patients with a known diagnosis of clear cell RCC. They received 0.1 mg/kg of EC17 prior to surgery, and then underwent intraoperative imaging during the operation. RESULTS: Fresh renal tumors were harvested from the operating room and confirmed FRa is highly expressed on 65% of clear cell RCC. In murine models, intraoperative imaging of RCC with EC17 revealed SBR of 8.2 1.1 for RCC10, 11.2 1.1 for 786-0 and 4.3 1.1 for UMRC2. Following surgery, intraoperative imaging of the surgical resection bed could identify residual disease in 24% more animals than visual inspection alone. In the human pilot study, targeted molecular imaging identified 2 out of 4 known RCC, and it had no false positive uptake. In these 2 cases, the SBR of the tumor to the background tissues was 3.7 and 4.6. In both cases, we confirmed disease clearance, and tumor fluorescence did not seem to correlate to nodule size or tumor grade. CONCLUSIONS: This is the first-in-human demonstration of identifying RCC during surgery with a targeted molecular contrast agent. This approach suggests that intraoperative molecular imaging with a targeted contrast agent may lead to better identification of malignancy and tumor borders. This pilot human study provides proof-ofprinciple that this technology may be feasible in the intraoperative setting. Source of Funding: None
e695
MP57-15 EN BLOC LIGATION OF RENAL VESSELS DURING LAPAROSCOPIC NEPHRECTOMY AND NEPHROURETERECTOMY Mariam Hult*, Mikkel Fode, Claus Dahl, Nessn Azawi, Roskilde, Denmark INTRODUCTION AND OBJECTIVES: Conventionally individual ligation of the renal artery and vein with clips is performed during laparoscopic nephrectomy (LN). Concomitant ligation of the vessels (en bloc ligation) is not standard procedure, due to an expected risk of stapler dysfunction and arteriovenous fistulas (AVF). However, recent studies suggest that en bloc ligation may be a safe procedure offering a reduction in surgical time. The objective of this study was to compare en bloc ligation, using EndoGIA stapler 45/2.5 mm (Covidien Inc, Mansfield, MA), with conventional individual ligation, during LN and laparoscopic nephroureterectomy (LNU), regarding surgical time, blood transfusions and development of AVF. METHODS: A retrospective chart review of all patients, undergoing LN or LNU at the Department of Urology, Roskilde Hospital, between January 2010 and April 2014, with a follow-up of minimum 6 months, was performed. Demographic data, indication for surgery, method of ligation, blood transfusions and development of CT-verified AVF were collected. Wilcoxon rank sum test, chi square test and Fisher’s exact test were used for univariate analyses. Multivariate analyses were performed with linear and logistic regression. RESULTS: 228 patients underwent LN and 56 patients underwent LNU. In the LN group, 77 patients (34%) underwent en bloc ligation. The surgical time was significantly reduced in the en bloc group, with a median of 90 minutes (range 30-180) compared to 110 minutes (range 40-240) in the conventional ligation group (p¼0.0001). The difference remained significant after controlling for age, gender, indication for surgery, blood transfusions and robotic surgery (-26 min [95% CI; -17 to -36 min], p<0.0001). Three en bloc patients and one conventional ligation patient received blood transfusions. The difference neither reached statistical significance in the univariate analysis (p¼0.11) nor after controlling for age, gender, indication for surgery and robotic surgery (p¼0.068). In the LNU group, 7 patients (13%) underwent en bloc ligation. There was no significant difference between conventional ligation and en bloc ligation in surgical time on either univariate (p¼0.8) or multivariate (p¼0.07) analyses. None of the patients needed blood transfusions. With a mean follow-up of 13 months (range 6-50), no AVF were found in any of the 284 patients. CONCLUSIONS: En bloc ligation appears to be safe and can reduce the surgical time during LN without increased risk of blood transfusions, or development of AVF. Further studies are needed to assess possible advantages using the method during LNU. Source of Funding: None
MP57-16 ANTIPLATELET/ANTICOAGULATION THERAPY DOES NOT INCREASE IMMEDIATE COMPLICATIONS IN PATIENTS UNDERGOING ROBOTIC PARTIAL NEPHRECTOMY (RPN) Andrew Leone*, George Turini, Joseph Brito, Timothy Tran, Joseph Renzulli, Gyan Pareek, Dragan Golijanin, Providence, RI INTRODUCTION AND OBJECTIVES: Robotic assisted laparoscopic partial nephrectomy (RPN) has become the standard of care in the management of small renal masses. We sought to compare patients on anticoagulation who underwent robotic partial nephrectomies to those without anticoagulation. METHODS: 129 patients who underwent robotic partial nephrectomy by a single surgeon at our institution from 2011 to 2014 were retrospectively reviewed. This cohort included 30 patients on preoperative anticoagulation/antiplatelet agents including aspirin, Coumadin, Clopidogrel. 14 patients remained on aspirin throughout the perioperative period. Perioperative parameters were obtained from chart reviewed and compared using Fisher’s exact test.
e694
and one for which there is limited published outcomes and guidelines. We investigated outcomes of this nephron sparing approach for local surgical excision of LG UTUC with large tumor burden >1.5cm using percutaneous endoscopic resection. METHODS: A retrospective analysis of all cases by a single surgeon in an academic center over a five-year period (2009-2014) was performed. We identified 29 patients with upper tract urothelial neoplasms >1.5cm having undergone percutaneous resection as primary treatment. Demographic and statistical analysis of patient variables as well as surgical and pathological outcomes was undertaken. Of the 29 total, 9 women and 20 men with a mean age of 63.6 (47-76) underwent percutaneous resection (right 16 / left 13). Surgical access was achieved by the surgeon. Resection was performed through a 34 Fr renal sheath using a 26 Fr nephroscope and 3mm extended length laparoscopic instruments or 26 Fr extended length resectoscope. RESULTS: One patient who underwent resection of 10 cm LG tumor had a complicated post-operative course necessitating completion radical nephroureterectomy (RNU) on post-operative day nine due to renal infarction. Final renal pathology demonstrated no residual tumor. Of the remaining 28 patients in this series, 21 (72.4%) were confirmed to have LG UTUC on final pathology, two patients (6.9%) were upstaged with HG UTUC on final pathology necessitating completion RNU, and five patients (17.2%) had LMP. Mean tumor size was 2.8 cm (1.5cm - 10cm). Mean follow-up duration was 22.7 months (9 mo - 65 mo). During this observation period, recurrences were found in 5/17 (29.4%) LG UTUC patients, and 0/5 LMP patients. All recurrences were LG and treated with ureteroscopic laser ablation. Tract tumor seeding not observed. CONCLUSIONS: Low risk UTUC can be effectively managed with percutaneous endoscopic tumor resection. Patients that are found to have characteristics of HG UTUC may be best managed with completion RNU. Resection within the renal collecting system carries different risks and challenges that can be overcome with experience. Although larger studies and more data would be required to create guidelines for management of UTUC, percutaneous resection of larger LG tumors of the upper tract may be a safe and feasible option to aid in nephron preservation. Patients should be carefully selected and willing to undergo strict and lengthy follow up. Source of Funding: None
MP57-12 NO PROVEN BENEFIT OF POSTOPERATIVE DRAINAGE AFTER ROBOTIC PARTIAL NEPHRECTOMY Benoit Peyronnet*, Zineddine Khene, Rennes, France; Benjamin Pradere, Tours, France; Gregory Verhoest, Romain Mathieu, Rennes, France; Mathieu Roumiguie, Jean-Baptiste Beauval, Baumert, Paris, France; Toulouse, France; Christophe Vaessen, Herve phane Droupy, Nimes, France; Alexandre de la Taille, Cre teil, Ste France; Jean-Christophe Bernhard, Bordeaux, France; Nicolas Doumerc, Toulouse, France; Morgan Roupret, Paris, France; Karim Bensalah, Rennes, France INTRODUCTION AND OBJECTIVES: Despite little evidence in the literature, most surgeons leave a drain postoperatively after robotic partial nephrectomy (RPN). The aim of this study was to assess the impact of a post-operative drainage after RPN. METHODS: A retrospective multicentric study was conducted including all the RPN from 8 centers between 2009 and 2013. Two centers have stopped using postoperative drainage after a few dozen of cases. Preoperative characteristics, complication rates (according to Clavien score), the need for postoperative imaging or procedure (surgical or radiological) and length of hospital stay were compared between the groups postoperative drainage (D) and no postoperative drainage (ND) using c2 test for discrete variables and Mann-Whitney test for continuous variables.
Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
RESULTS: Among 521 RPN included, 105 were done without postoperative drainage (20 %). In the ND group, surgeons, surgeons were more experienced (> 50 procedures: 53% vs. 1%; p< 0,0001) but tumors were more complex (RENAL SCORE: 7,.5 vs. 6.4; p< 0.0001). Patients in both groups had similar complication rates (22.9% vs. 21.7%; p¼0.79) and major complication rates (Clavien 3: 9.5% vs. 9.6%; p¼0.38). The omission of postoperative drainage did not increase the risk of needing a CT scan (RR¼ 0.9; IC95%: 0.5-1.5). Conversely, length of hospital stay was shorter in the ND group (4.3 vs. 5.8 days; p¼ 0.0005). There were 6 urinary fistula, 4 in the D group (1%) and 2 in the ND group (1.9%; p¼0.42) but CT scan was needed to confim this diagnosis in each cases in both groups. Reoperation or radiological/ endoscopic procedures were needed in 100% of urinary fistula (none was cured only by the post-operative drain). CONCLUSIONS: The omission of postoperative drainage does not increase the risk of postoperative complication, CT scan or procedures. Conversely, it could increase length of stay. Postoperative drainage N¼416
no postoperative drainage N¼105
Complications
21.7%
22.9%
0.79
Major complications (Clavien grade > 2)
9.5%
9.6%
0.38
Postoperative CT-scan
13.3%
14.9%
0,68
5,8
4,3
0.0005*
Length of stay (days)
p-value
Source of Funding: none
MP57-13 LAPAROSCOPIC VERSUS PERCUTANEOUS CRYOABLATION FOR T1 RENAL MASSES: AN ITALIAN MULTICENTRIC STUDY Bernardino de Concilio*, Calogero Cicero, Dario del biondo, , Guglielmo Zeccolini, Bassano del Grappa, Italy; Fulvio Lagana Alessandro Pinzani, Dolo, Italy; Piero Pellegrini, Tiziano Stocca, Gorizia, Italy; Luca Balestreri, Martina Urbani, Aviano, Italy; Giovanni Carbognin, Negrar, Italy; Giuseppe Casarrubea, Fabio Zattoni, Padova, Italy; Davide Barbisan, Franco Merlo, Treviso, Italy; Salvatore Siracusano, Fulvio Stacul, Trieste, Italy; Antonio Celia, Bassano del Grappa, Italy INTRODUCTION AND OBJECTIVES: Detection of localized RCC has increased over the past 2 decades and both laparoscopic (LCA) and percutaneous cryoablation (PCA) have demonstrated decreased morbidity with acceptable rates of oncologic success. The aim of our study was to evaluate the short and medium long term oncologic outcome of LCA and PCA of T1 renal tumors. METHODS: We performed an Italian multicentric prospective study of patients who underwent cryoablation (LCA or PCA) as their primary ablative treatment for cT1 solid renal masses. A total of 158 patients were identified: 22 undergoing LCA and 136 PCA. We used PADUA Score System for preoperative tumors classification. Follow-up included serial abdominal imaging (CT, MRI or CEUS), serum creatinine and eGFR. Recurrence-free survival (RFS) was defined by absence of evidence of local disease recurrence on followup imaging. RESULTS: Mean oncologic follow-up was 27.7 (21.6) months for LCA and 13.2 (11.8) for PCA. Kaplan-Meier estimated RFS curves for both groups demonstreated no difference (24-months RFS were 90% for LCA and 86% for PCA) even if stratified by biopsyproven RCC. A total of 8 patients experienced disease recurrence with no difference between the two groups. The treatment success rate is 90% (mean 28 months) for LCA and 95% (mean 13 months) for PCA. 133 biopsy were performed. Malignant features were demonstrated in the 86% in the LCA and 75% in the PCA group. Postoperative complications rate (Clavien-Dindo >1) was 13.6% in LCA and 2.2% in PCA groups. No patient required conversion to
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Sunday, May 17, 2015
open surgery. Only 1 patient in PCA group required a reintervention performed by radiological embolization. Both groups had a comparable mean postoperative serum creatinine and eGFR was stable over time in both groups. According to Clinical Practice Guideline for Acute Kidney Injury (AKI) only 5% of patients had an acute compromise renal function (AKI Stage 1) which resolved in a few days. At Univariate and Multivariate analysis predictors of Recurrence Disease (RD) included PADUA Score 8 (HR ¼ 9.99) and ASA risk 4 (HR ¼ 11.23). Limitations of our study are: limited follow-up, oncologic outcomes based only on radiographic criteria and lack of pathologic data in some cases. CONCLUSIONS: Our multicentric analysis shows that oncologic outcomes and complication rate in PCA treatment and LCA treatment have no statistical difference. Both treatments are safe and effective is the management of cT1 solid renal masses in patients who are poor candidates for conventional surgery. Longer follow-up is required to truly interpret oncologic outcomes after cryoablation. Source of Funding: none
MP57-14 INTRAOPERATIVE MOLECULAR DIAGNOSTIC IMAGING CAN IDENTIFY RENAL CELL CARCINOMA DURING NEPHRECTOMY Thomas Guzzo*, Jane Keating, Jack Jiang, Elizabeth DeJesus, Sunil Singhal, Philadelphia, PA INTRODUCTION AND OBJECTIVES: Clear cell histology is the most commonly diagnosed subtype of renal cell carcinoma (RCC) and accounts for the majority of renal cancer deaths. The most important prognostic indicator following surgery is a complete resection, however margin status can often be difficult to assess intraoperatively, particularly during partial nephrectomy given the time constraints related to renal hilar clamping. Thus, we hypothesized that a targeted molecular imaging approach could be used as an adjunct during surgery to identify the tumor margins and confirm disease clearance in the resection bed. METHODS: Multiple human tumors and murine RCC cell lines were tested for folate receptor alpha (FRa) expression by immunohistochemistry. A novel tracer targeting FRa (EC17) on RCC was tested on athymic mice (n¼50) bearing human renal carcinoma cell lines (RCC10, 786-0, UMRC2). Signal-to-background ratio (SBR) of the tumor to surrounding normal tissue was measured for each model. Based on these preclinical findings, we conducted a pilot study on 4 human patients with a known diagnosis of clear cell RCC. They received 0.1 mg/kg of EC17 prior to surgery, and then underwent intraoperative imaging during the operation. RESULTS: Fresh renal tumors were harvested from the operating room and confirmed FRa is highly expressed on 65% of clear cell RCC. In murine models, intraoperative imaging of RCC with EC17 revealed SBR of 8.2 1.1 for RCC10, 11.2 1.1 for 786-0 and 4.3 1.1 for UMRC2. Following surgery, intraoperative imaging of the surgical resection bed could identify residual disease in 24% more animals than visual inspection alone. In the human pilot study, targeted molecular imaging identified 2 out of 4 known RCC, and it had no false positive uptake. In these 2 cases, the SBR of the tumor to the background tissues was 3.7 and 4.6. In both cases, we confirmed disease clearance, and tumor fluorescence did not seem to correlate to nodule size or tumor grade. CONCLUSIONS: This is the first-in-human demonstration of identifying RCC during surgery with a targeted molecular contrast agent. This approach suggests that intraoperative molecular imaging with a targeted contrast agent may lead to better identification of malignancy and tumor borders. This pilot human study provides proof-ofprinciple that this technology may be feasible in the intraoperative setting. Source of Funding: None
e695
MP57-15 EN BLOC LIGATION OF RENAL VESSELS DURING LAPAROSCOPIC NEPHRECTOMY AND NEPHROURETERECTOMY Mariam Hult*, Mikkel Fode, Claus Dahl, Nessn Azawi, Roskilde, Denmark INTRODUCTION AND OBJECTIVES: Conventionally individual ligation of the renal artery and vein with clips is performed during laparoscopic nephrectomy (LN). Concomitant ligation of the vessels (en bloc ligation) is not standard procedure, due to an expected risk of stapler dysfunction and arteriovenous fistulas (AVF). However, recent studies suggest that en bloc ligation may be a safe procedure offering a reduction in surgical time. The objective of this study was to compare en bloc ligation, using EndoGIA stapler 45/2.5 mm (Covidien Inc, Mansfield, MA), with conventional individual ligation, during LN and laparoscopic nephroureterectomy (LNU), regarding surgical time, blood transfusions and development of AVF. METHODS: A retrospective chart review of all patients, undergoing LN or LNU at the Department of Urology, Roskilde Hospital, between January 2010 and April 2014, with a follow-up of minimum 6 months, was performed. Demographic data, indication for surgery, method of ligation, blood transfusions and development of CT-verified AVF were collected. Wilcoxon rank sum test, chi square test and Fisher’s exact test were used for univariate analyses. Multivariate analyses were performed with linear and logistic regression. RESULTS: 228 patients underwent LN and 56 patients underwent LNU. In the LN group, 77 patients (34%) underwent en bloc ligation. The surgical time was significantly reduced in the en bloc group, with a median of 90 minutes (range 30-180) compared to 110 minutes (range 40-240) in the conventional ligation group (p¼0.0001). The difference remained significant after controlling for age, gender, indication for surgery, blood transfusions and robotic surgery (-26 min [95% CI; -17 to -36 min], p<0.0001). Three en bloc patients and one conventional ligation patient received blood transfusions. The difference neither reached statistical significance in the univariate analysis (p¼0.11) nor after controlling for age, gender, indication for surgery and robotic surgery (p¼0.068). In the LNU group, 7 patients (13%) underwent en bloc ligation. There was no significant difference between conventional ligation and en bloc ligation in surgical time on either univariate (p¼0.8) or multivariate (p¼0.07) analyses. None of the patients needed blood transfusions. With a mean follow-up of 13 months (range 6-50), no AVF were found in any of the 284 patients. CONCLUSIONS: En bloc ligation appears to be safe and can reduce the surgical time during LN without increased risk of blood transfusions, or development of AVF. Further studies are needed to assess possible advantages using the method during LNU. Source of Funding: None
MP57-16 ANTIPLATELET/ANTICOAGULATION THERAPY DOES NOT INCREASE IMMEDIATE COMPLICATIONS IN PATIENTS UNDERGOING ROBOTIC PARTIAL NEPHRECTOMY (RPN) Andrew Leone*, George Turini, Joseph Brito, Timothy Tran, Joseph Renzulli, Gyan Pareek, Dragan Golijanin, Providence, RI INTRODUCTION AND OBJECTIVES: Robotic assisted laparoscopic partial nephrectomy (RPN) has become the standard of care in the management of small renal masses. We sought to compare patients on anticoagulation who underwent robotic partial nephrectomies to those without anticoagulation. METHODS: 129 patients who underwent robotic partial nephrectomy by a single surgeon at our institution from 2011 to 2014 were retrospectively reviewed. This cohort included 30 patients on preoperative anticoagulation/antiplatelet agents including aspirin, Coumadin, Clopidogrel. 14 patients remained on aspirin throughout the perioperative period. Perioperative parameters were obtained from chart reviewed and compared using Fisher’s exact test.