EVALUATION OF SURGICAL TREATMENT OF HYPERALDOSTERONISM

493 RADICAL NEPHRECTOMY IS NOT SUPERIOR TO NEPHRON SPARING SURGERY IN PT1B-PT2N0M0 RENAL TUMOURS: A MATCHED COMPARISON ANALYSIS IN 546 CASES

P36 ADRENAL SURGERY AND KIDNEY TRANSPLANTATION Thursday, 27 March, 14.00-15.30, Purple Hall 1

Patard J.J.1, Bensalah K.C.1, Pantuck A.J.2, Klatte T.2, Crepel M.1, Verhoest G.1, Guille F.1, Manunta A.1, Vincendeau S.1, Avakian R.1, Bellec L., Soulie M., Rischmann P., Albouy B.43ᚏVWHU&4, Bernhard J.C.5, Ferriere J.M.5, Lacroix B.6, Tostain J.6, De La Taille A.7, Abbou C.C.7, Salomon L.7, Colombel M.8, Ficarra V.9, Cindolo L.10, Bertini R.11, Karakiewicz P.I.12, Montorsi F.11, Belldegrun A.S.2 1 Rennes University Hospital, Dept. of Urology, Rennes, France, 2UCLA, Dept. of Urology, Los Angeles, United States of America, Toulouse University Hospital, Dept. of Urology, Toulouse, France, 4Rouen University Hospital, Dept. of Urology, Rouen, France, 5Bordeaux University Hospital, Dept. of Urology, Bordeaux, France, 6Saint Etienne University Hospital, Dept. of Urology, Saint Etienne, France, 7Creteil University Hospital, Dept. of Urology, Creteil, France, 8Lyon University Hospital, Dept. of Urology, Lyon, France, 9Padua University Hospital, Dept. of Urology, Padua, Italy, 10G. Rummo Hospital, Dept. of Urology, Benevento, Italy, 118QLYHUVLW\ 9LWD  6DOXWH 6DQ 5DᚎDHOH 'HSW RI 8URORJ\ 0LODQ ,WDO\ 12 CHUM, Dept. of Urology, Montreal, Canada

Introduction & Objectives: Partial nephrectomy (PN) is currently considered as the standard of care IRU VPDOO UHQDO WXPRXUV 8S WR QRZ WKH  FP FXW Rᚎ KDV EHHQ JHQHUDOO\ DFFHSWHG IRU GHOLQHDWLQJ the respective indications of partial and radical nephrectomy (RN). However, recent reports have challenged this arbitrary limit. We present here, the results of a large matched comparison between 31DQG51LQWKHVHWWLQJRIRUJDQFRQᚏQHGWXPRXUPHDVXULQJPRUHWKDQFP Material & Methods: Out of a multi-institutional database including 2406 PN procedures, 289 which were performed for pT1b-pT2N0M0 renal tumours were selected for comparison with a matched radical nephrectomy group. For that purpose, out of 1507 renal tumours operated by radical nephrectomy (RN) and having identical TNM stage, 257 were selected after matching with the PN group for tumour size and Fuhrman grade. Qui-square and Student t tests were used for comparing qualitative and quantitative variables, respectively. Log rank test was used for comparing survival between the 2 groups. Results: Five hundred and forty six renal procedures were included in this retrospective study. During DPHDQIROORZXSRIPRQWKVRQO\ SDWLHQWVGLHGIURPFDQFHU7KH31Q  DQGWKH 51JURXSVQ  ZHUHFRPSDUDEOHIRUDJHDWGLDJQRVLVYVS  7XPRXUVL]H YV  FP S   7 VWDJH 7   YV   S   DQG )XKUPDQ JUDGH **   YV   S   :KHQ FRPSDULQJ FDQFHU VSHFLᚏF VXUYLYDO EHWZHHQ WKH  JURXSV survival curves perfectly overlapped (log rank test, p=0.9). When searching for predictive parameters IRUVXUYLYDO7VWDJH)XKUPDQJUDGHDQGDJHDWGLDJQRVLVZKHUHVLJQLᚏFDQWSUHGLFWRUVLQXQLYDULDWH analysis while T stage and age remained independent prognostic parameters in multivariate analysis. Surgical approach, in this selected low risk population had absolutely no impact on outcome either in uni or in multivariate analysis. Conclusions: 7KHSUHVHQWVWXG\FRQᚏUPVWKDWIRUFRPSDUDEOHS7S710WXPRXUV31DQG51DUH HTXLYDOHQWUHJDUGLQJFDQFHUFRQWURO'XHWRLWVORQJWHUPEHQHᚏWLQWHUPRIUHQDOIXQFWLRQWKHIHDVLELOLW\ RI166VKRXOGEHV\VWHPDWLFDOO\FRQVLGHUHGLQRUJDQFRQᚏQHGUHJDUGOHVVRIWXPRXUVL]H

Porpiglia F.1, Billia M.1, Selvaggi M.2, Novello P.2, Volpe V.1, Ragni F.1, Scagliotti G.2, Scarpa R.M.1 San Luigi Hospital, University of Turin, Division of Urology, Orbassano (TO), Italy, 2San Luigi Hospital, University of Turin, Division of Pulmonary Oncology, Orbassano (TO), Italy

1

Introduction & Objectives: The adrenal gland is one of the most frequent site of metastasis of lung cancer (LC). The management of adrenal metastases is debated. Their removal by laparoscopic adrenalectomy (LA) has been shown to be an attractive option and few small series with acceptable oncological outcomes have been reported. Aim of this prospective VWXG\LVWRHYDOXDWHLQRXUH[SHULHQFHWKHUROHHᚑFDF\VDIHW\DQGRXWFRPHVRI/$IRUDGUHQDO metastases in patients treated with chemo-radiotherapy for advanced LC. Material & Methods: From July 2002 to October 2007, 20 LA for metastases of LC were performed at our centre. 16 patients were enrolled in this prospective study. All were diagnosed with a locally advanced LC without surgical indications and underwent chemotherapy with or without radiotherapy. The patients who were diagnosed during follow-up with adrenal metastases alone at CT scan or PET underwent LA. For each patient the following variables were evaluated: age, gender, side and size of the lesion, pathology, operative time, blood loss, conversion to open surgery, hospital stay, intra and postoperative complications, pre and postoperative (1 month) performance status (Karnofsky Performance Status Scale 6FRUH 3DWLHQWVZHUHVWUDWLᚏHGDFFRUGLQJWRWKHOHVLRQVL]H*URXS$FPYV*URXS%! cm). A statistical analysis was carried out to assess peri-operative morbidity and oncological outcomes. Results: 0HDQOHVLRQVL]HZDV FPDQGPHDQRSHUDWLYHWLPHZDV  PLQ&RQYHUVLRQWRRSHQVXUJHU\ZDVQHFHVVDU\LQFDVHVGXHWRORFDOLQᚏOWUDWLRQDQGODUJH VL]H RI WKH OHVLRQ  DQG  FP  0HDQ SUH DQG SRVWRSHUDWLYH SHUIRUPDQFH VWDWXV VFRUH ZDV DQG UHVSHFWLYHO\1RLQWUDRUSRVWRSHUDWLYHFRPSOLFDWLRQV RFFXUUHG,QDOOFDVHVSDWKRORJ\FRQᚏUPHGPHWDVWDVLVRI/&0HDQIROORZXSZDV  months. 12 patients (75%) died (1 local recurrence, 1 acute pulmonary embolism and 10 systemic progressions with neoplastic cachexia), while 4 patients (25%) are alive with no evidence of progression. As far as the oncological safety is concerned, 2 positive surgical PDUJLQVDQGFRQYHUVLRQVWRRSHQVXUJHU\GXHWRORFDOLQᚏOWUDWLRQZHUHREVHUYHGLQ*URXS% DQGQRQHLQJURXS$S  1RVWDWLVWLFDOO\VLJQLᚏFDQWGLᚎHUHQFHZDVIRXQGEHWZHHQ*URXS A and Group B for all the other variables analysed. Conclusions: LA for adrenal metastases in patients with advanced LC improves the patient’s performance status, while overall survival remains low. LA seems to be oncologically safer when lesion size is < 5 cm.

495

496

CHROMOGRANIN A IN PROGNOSIS OF PHEOCHROMOCYTOMA DIAGNOSED PATIENTS

EVALUATION OF SURGICAL TREATMENT OF HYPERALDOSTERONISM

Safarik L.S.1, Bilek R.B.2, Novak K.N.1, Dvoracek J.D.1

Safarik L.S.1, Novak K.N.1, Zelinka T.Z.2, Pesl M.P.1, Macek P.M.1, Dvoracek J.D.1

1

2

Charles University, Dept. of Urology, Prague, Czech Republic, Institute of Endocrinology, Ministry of Health, Prague, Czech Republic Introduction & Objectives: Chromogranin A (CgA), a protein of neuroendocrine cell secretory granules, may be a precursor of biologically active peptides and its serum level may enhance diagnosis and future prognosis of people with pheochromocytoma (Ph), either benign or malignant. Though pheochromocytoma adrenal scaled score (PASS) has been employed in 2002 and possible malignant potential could be established accordingly (>4) after the successful surgery, the future development is not clear and many Ph will recur or show remote secondaries. Material & Methods: 7ZHQW\WZRSDWLHQWVZHUHRSHUDWHGIRU3KPHQDQGZRPHQ0(1E $ solid-phase two site immunoradiometric assay was used with primary immobilized monoclonal antibody and secondary radio iodinated monoclonal antibody, both directed against the central domain of the CgA molecule (145-245). CgA was measured in 50 ul of EDTA plasma samples. Reference range was 20150 ng/ml for plasma EDTA samples, and 19.4 - 98.1 ng/ml for serum samples. Plasma/urine nephrins, as well as tumour mass and PASS score were recorded. Patients were invited to have plasma CgA, nephrins and U/S done 1 year after the surgery. Results: 7KHPHDQSUHVXUJHU\FRQFHQWUDWLRQRISODVPD&J$ZDVQJPO6' DQGSRVWRS QJPO UHVSHFWLYHO\FRQWUROVZLWKQRQIXQFWLRQLQJDGUHQDOPDVVQ QJPO :HGLGQRW ᚏQGDQ\DVVRFLDWLRQRI&J$ZLWKDJHEXWZHGLGIRXQGDVVRFLDWLRQRI&J$ZLWKUHPRYHGPDVV&J$QJ PO   OQ>ZHLJKWJ @ದ3HDUVRQ6SHDUPDQDQG5VTXDUHG6LJQLᚏFDQFH of t-test was 0.0016, see Fig. 1. We also found correlation of CgA with PASS: CgA (ng/ml) = 126*PASS 3HDUVRQ6SHDUPDQDQG5VTXDUHGLVS  :HKDYHGHYHORSHGD special index incorporating meta and normetanephrine, as most sensitive, age and weight and plotted it with CgA via linear regression (N=18). 33,   &J$ &RUUHODWLRQ was 0.5266, p <0.0248, giving the biggest values in patients with bulkiest tumors. Conclusions: Since the Ph can recur even many years after successful surgery, currently no single tumour marker could be applied to predict prognosis. Huge tumors usually tend to have many degenerative, and hence non-functioning, features, incl. internal bleeding, while others show malignant cell and tissue signs. Chromogranin A and composite index may be the early pointers to predict recurrence and stipulate frequent checkups.

Eur Urol Suppl 2008;7(3):194

494

ROLE OF LAPAROSCOPIC ADRENALECTOMY FOR THE MANAGEMENT OF METASTASIS IN ADVANCED LUNG CANCER

1 Charles University, Dept. of Urology, Prague, Czech Republic, 2Charles University, Dept. of Internal Medicine, Prague, Czech Republic

Introduction & Objectives: Hyperaldosteronism induced hypertension is one of the rare EORRGSUHVVXUHHOHYDWLRQFXUDEOHZLWKVXUJHU\/DSDURVFRS\LVDQHᚎHFWLYHPHDQRIWUHDWPHQW albeit not in all cases. Serum level of aldosteron (A) may be elevated, but most sensitive diagnostic tool is A/PRA ratio. Material & Methods: All 56 patients were referred to the surgery for indolent hypertension. 7KHVHUXPH[DPLQDWLRQRI$35$$35$UDWLRQRUPDO DQG&7VFDQZHUHURXWLQHO\ performed. In cases of no mass on CT scan (2), separate blood samples form adrenal veins ZHUHSUHIRUPHG$OOEXWSDWLHQWVKDGODSDURVFRSLFUHPRYDORIWKHIXQFWLRQLQJDGUHQDOPDVV Pathology did not reveal any malignancy. Results: As many as 56 patients have been treated surgically over the period of 7 years. Male WR IHPDOH UDWLR ZDV    ZLWK IHPDOHV EHLQJ \RXQJHU  YV  \HDUV PHDQ  /HIWWRULJKWSUHYDOHQFHZDV DQGWKHPHDQZHLJKWRIWKHVSHFLPHQZDVJ  3UHRSPHDQYDOXHRI$ZDVQJ/ದ SRVWRSQJP/  QRUPDO  ದ  +\SRSRWDVVHPLD UHWXUQHG WR QRUPDO LQ DOO EXW RQH 7ZHQW\ VL[ SWV ZHUH treated with surgery exclusively and do not require any medical therapy further (46%). LeadWLPHWRGLDJQRVLVZDV\HDUVDQGWXPRXUZHLJKWZDVVPDOOHUE\JS7KH\ZHUH DOVR E\  \HDUV \RXQJHU 2WKHU  SWV   VWLOO UHTXLUH PLOG DQWLK\SHUWHQVLYH WKHUDS\ with average 2.5 medicals for arterial hypertension. Those people were in average 55 years ROG WKHLU OHDG WLPH WR GLDJQRVLV ZDV  \HDUV DQG WKH\ XVHG  DQWLK\SHUWHQVLYH GUXJV SUHRSHUDWLYHO\YVS 2YHUDOOKRVSLWDOVWD\ZDVGD\V7KUHHSHRSOHKDGELODWHUDO disease, 4 developed secondary hyper A and 6 have not come to post-op check-up. We found VLJQLᚏFDQW FRUUHODWLRQ EHWZHHQ %0, DQG SUHRS $ VHUXP OHYHO PHDQ %0,  6'  PHDQ$QJ/6'SDQGVLJQLᚏFDQWFRUUHODWLRQEHWZHHQ%0,DQGZHLJKW RIWKHUHPRYHGVSHFLPHQPHDQJ SWWHVWIRUGHSHQGDEOHYDULDEOHV 7KHUH was nor relations between post-op PRA and BMI. Conclusions: Long-lasting medical resistant hypertension with hypopotassemia and high A/R UDWLRRILVGLDJQRVWLFIRUK\SHUDOGRVWHURQLVP5DGLRORJLFFRQᚏUPDWLRQRIDVPDOOWXPRXU is indicative, but few laesions require separate blood sampling from adrenal veins, since there is no mass visible on the CT/NMR. In those cases, PET scan could avoid sampling invasivity prior to surgery. Some cases turn out to be combined with arterial hypertension (mostly with obesity and high BMI), which require further medical treatment. Depending on age and leading time of medical treatment, patients still need antihypertensive therapy after the surgery.