1425 PARTIAL NEPHRECTOMY PROVIDES EQUAL OVERALL SURVIVAL AND CANCER-SPECIFIC SURVIVAL RATES TO RADICAL NEPHRECTOMY FOR T1B KIDNEY CANCER

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THE JOURNAL OF UROLOGY姞

nephrectomy before and after 2005 decreased by 1.53 days (95%CI 0.56, 2.50) and this was statistically significant on multivariate analysis (p-value⫽0.002). The LOS of patients who underwent open radical nephrectomy decreased over time where as MIS radical nephrectomy patients remained stable. Nonetheless, an LOS difference of 1.49 days (95%CI 0.42, 2.56; p⫽0.007) between open and MIS procedures was evident after the introduction of the common clinical pathway. CONCLUSIONS: The implementation of a common clinical pathway for all patients undergoing renal surgery has resulted in a significantly decreased LOS and in LOS becoming more similar between open and MIS approaches. Clinical pathways for kidney surgery should be utilized and continually assessed to optimize efficiency as well as patient outcomes.

Vol. 187, No. 4S, Supplement, Tuesday, May 22, 2012

spectively. A total of five (10.2%) patients developed recurrent disease, and three (6.1%) patients died of metastatic RCC. These findings are compared to prior reports (Table I). CONCLUSIONS: Previous reports suggest that PN for tumors ⬎ 7cm may be associated with decreased oncologic efficacy compared to RN. Here we present the largest single institutional series and a pooled analysis noting that PN can safely be performed in tumors ⬎7 cm, and long-term cancer free survival can be achieved with minimal compromise of renal function. Author

Institution

# of Tumors ≥ 7cm

Median Follow Up (Mo)

# (%) Positive Margins

Overall survival 5years

Median Tumor size(cm)

Tumor size range (cm)

Median Preop creat (mg/dL)

Median Postop creat (mg/dL)

Conclusions

Fox Chase Cancer Center

N= 52

14.1

5 (10%)

94.8%

8.5

7-30

1.18

1.30

Oncologic efficacy and renal function preserved for tumors ≥ 7cm

Memorial Sloan Kettering

N= 37

17

0

?

7.5

7-19

N/A

N/A

Oncologic efficacy and renal function preserved for tumors ≥ 7cm

Breau R et al 2010

Mayo Clinic

N=69

38

N/A

75%

7.5

N/A

1.2

9.5%

Oncologic efficacy and renal function preserved for tumors > 7cm

Jeldres C

Europe, multiinstitutional

N= 29

54

N/A

84%

8.5

N/A

N/A

N/A

PN for tumors >7cm associated with 5.3-fold increase in mortality compared to RN

University of Paris, France

N= 16

70

5 (31%)

66%

8.4

N/A

1.32

1.41

Oncologic safety compromised for tumors >7cm

Cleveland Clinic

N= 50

47

N/A

82%

9.9

N/A

N/A

N/A

Tumors > 7cm had decreased survival, increased recurrence

Current study 2011 Karellas M et al 2010

et al 2009

Peycelon M et al 2009

Hafez KS et al 1999

increase

Source of Funding: Kidney Cancer Keystone Program

1425 PARTIAL NEPHRECTOMY PROVIDES EQUAL OVERALL SURVIVAL AND CANCER-SPECIFIC SURVIVAL RATES TO RADICAL NEPHRECTOMY FOR T1B KIDNEY CANCER Sandra Koo*, Paul Kozlowski, Seattle, WA Source of Funding: Supported by The Sidney Kimmel Center for Prostate and Urologic Cancers

1424 PARTIAL NEPHRECTOMY FOR RENAL MASSES > 7CM IS TECHNICALLY FEASIBLE, ONCOLOGICALLY SOUND, AND PRESERVES RENAL FUNCTION Christopher Long, Philadelphia, PA; Daniel J Canter, Atlanta, GA; Brian Cronson*, Alexander Kutikov, Tianyu Li, Rosalia Viterbo, David Y.T. Chen, Richard Greenberg, Robert Uzzo, Philadelphia, PA INTRODUCTION AND OBJECTIVES: Partial nephrectomy (PN) preserves renal function and has demonstrated oncologic equivalence to radical nephrectomy (RN) in T1a/b renal tumors. To date, reports of PN for tumors ⬎7cm (pT2) are sparse and reveal contradictory oncologic outcomes. We assessed our institutional series of patients undergoing PN for renal masses ⬎pT2 and compared outcomes to reported literature. METHODS: We reviewed our prospectively maintained institutional kidney cancer database of over 2000 patients and identified 52 patients who underwent PN for tumors ⬎ 7 cm. Demographic, clinical, and survival data were analyzed. RESULTS: Median patient age and tumor size were 59 years (range⫽21-83) and 8.5 cm (range⫽7-30), respectively. Pre-operatively, 21 (40.3%) patients had CKD Stage III or higher. 23 (46.9%) patients had an absolute indication for NSS, 7 (14.3%) patients had a solitary kidney and 16 (32.7%) patients had bilateral tumors. Malignancy rate was 80 percent with clear cell (36.5%) and papillary (34.6%) histologies identified most commonly upon resection. Five and 10-year overall and RCC-specific survival rates were 94.8% and 75.9%, re-

INTRODUCTION AND OBJECTIVES: Cancer control equivalency has been demonstrated between radical and partial nephrectomy for patients with T1a kidney cancer. The results for T1b cancer are less demonstrated. We used a population-based database to explore overall survival and cancer survival rates in patients with T1b kidney cancer. METHODS: We retrospectively searched the Surveillance Epidemiology and End Results (SEER) database for all patients who had undergone either radical nephrectomy or partial nephrectomy for stage T1b kidney cancer between 1988 and 2003. We performed logistic regression to assess the ability of age, histology type, Fuhrman grade, and surgery type to predict overall- and cancer-specific survival. In addition, we used Kaplan-Meier life table analysis to evaluate actuarial survival probability as a function of surgery type. RESULTS: The cohort consisted of 2399 patients. The median follow up time and the median age were 58 months and 62 years (0-96), respectively. Of all patients, 8.5% had partial nephrectomy and 23.8% died during the follow-up period. The majority of patients were conventional clear cell type (85%), and 16% were Fuhrman grade III-IV. On multivariate analysis, age (HR 1.074; p⬍0.001) and Fuhrman grade (HR⫽1.846, p⬍0.001) and size (HR⫽1.018, p⫽0.016) were significant predictors of overall mortality. Surgery type was not a significant predictor of overall mortality on either univariate or multivariate analysis (p⬎0.05). On Kaplan-Meier actuarial analysis, mean time to overall (85.6 months vs. 87.2 months; p⫽0.674) and cancer-specific mortality (99.8 months vs. 98.7 months; p⫽0.513) were similar between patients that underwent either partial or radical nephrectomy. CONCLUSIONS: Partial nephrectomy provided equal overall survival rates and cancer-specific survival rates to radical nephrectomy for patients with T1b kidney cancer in this population-based study. Thus, partial nephrectomy should be considered one of the standard treatment options for patients presenting with clinical T1b kidney cancer. Source of Funding: None