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MP60-06 ONCOLOGICAL SAFETY AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE INTERNATIONAL ROBOTIC CYSTECTOMY CONSORTIUM
THE JOURNAL OF UROLOGYâ
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
MP60-06
MP60-07
ONCOLOGICAL SAFETY AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE INTERNATIONAL ROBOTIC CYSTECTOMY CONSORTIUM
THE ROLE OF ALVIMOPAN FOR RADICAL CYSTECTOMY
Matthias Saar*, Homburg Saar, Germany; Syed Johar Raza, John Binkowski, Buffalo, NY; Lee Richstone, New York, NY; Andrew Wagner, Boston, MA; Timothy Wilson, Duarte, CA; Joan Palou Redorta, Barcelona, Spain; Prokar Dasgupta, London, United Kingdom; James Peabody, Detroit, MI; Peter Wiklund, Stockholm, Sweden; Franco Gaboardi, Milan, Italy; Alex Mottrie, Aalast, Belgium; Stephan Siemer, Homburg Saar, Germany; Raj Pruthi, Chapel Hill, NC; Alon Weizer, Ann Arbor, MI; Francis Schanne, Newark, DE; Khurshid Guru, East Amherst, NY; Koon-ho Rha, Seoul, Korea, Republic of; Ashok Hemal, Winston-Salem, NC; Douglas Scherr, New York, NY; Michael Stockle, Homburg Saar, Germany INTRODUCTION AND OBJECTIVES: Despite being performed for over a decade with satisfactory early oncologic outcomes, there are still concern regarding the induction of local recurrence and port site metastasis following Robot-assisted Radical Cystectomy (RARC). To our knowledge no major clinical study evaluating early oncological failure (EOF) with long-term follow-up has been presented regarding RARC. We attempt to assess the oncological safety of RARC with emphasis on rapid local recurrence and port site metastasis in a multiinstitutional cohort. METHODS: The IRCC database comprising of 1549 patients from 22 institutions in 13 countries performing RARC was queried for EOF. EOF was defined as any presence of rapid local spread disproportional to the primary stage within one month and any port site metastasis after surgery. Additionally the lead surgeons from each institution were contacted to confirm any reports of early failure. Each incidence was analyzed to identify common variables which may be associated with EOF. RESULTS: In the entire database of 1549 patients, EOF was reported in 8 patients (0.5%). Majority patients were males (90%) with ASA of > 3 in 75% of them. Mean age was 67 years (range 42-80 years). No inadvertent spillage of urine was reported. No major postoperative complication was noted in all of the 8 patients. All of the patients had high grade disease, with negative margins, while only 2 patients had lympho-vascular invasion on final histopathology. Additionally in the data base 3 cases of port site metastasis were reported (0.2%). All of these patients had >T2 final pathological staging, with 2/12 and 1/8 positive lympho nodes in 2 cases. Specimen retrieval was performed using the standard lap-bag, without any reported urine spillage. Mean time to port site metastasis was 4 months (range 3-6 months). 2 metastases were in isolation, while 1 case had additional lung lesions. CONCLUSIONS: Early oncological failure and port site metastasis are rare but a significant outcome after RARC. Further prospective collection of factors associated with early failure, can help in a better understanding of this rare yet significant outcome.
Source of Funding: None
e635
Zachary Hamilton*, Josh Griffin, Moben Mirza, Jeffrey Holzbeierlein, Kansas City, KS INTRODUCTION AND OBJECTIVES: Radical cystectomy is a major surgical procedure that results in delayed return of bowel function, due to primary intestinal anastomosis. Alvimopan (Entereg) is an FDA approved peripherally acting m-opiod receptor antagonist that has shown favorable results for improved recovery of gastrointestinal function and decreased hospital length of stay, including studies specifically examining radical cystectomy. We aim to retrospectively review our experience utilizing Alvimopan with patients undergoing radical cystectomy for bladder cancer. METHODS: A retrospective review was performed of patients undergoing radical cystectomy at our institution. Patients were routinely provided with Alvimopan 12mg once preoperatively and twice daily postoperatively for a maximum of seven days. At our institution, radical cystectomy patients were routinely started on a clear liquid diet on postoperative day two, and a regular diet was given after return of bowel activity, evidenced by flatus or bowel movement. Time from initiation of clear liquid diet to tolerance of regular diet was recorded, as was total length of hospitalization. An unpaired t-test was utilized for statistics. RESULTS: A total of 40 patients were given Alvimopan and 60 patients did not receive Alvimopan from July 2011 to January 2013. Mean age for the Alvimopan cohort was 67.5 years and 67.7 years in the non-Alvimopan cohort. The Alvimopan cohort contained 78% male and 22% female. The non-Alvimopan cohort contained 73.3% male and 26.7% female. The mean length of time until tolerance of regular diet in the Alvimopan cohort was 2.3 days, yet it was 3.1 days in the non-Alvimopan cohort (p¼0.036). Mean length of hospitalization for the Alvimopan cohort was 5.9 days, while it was 6.6 days in the non-Alvimopan cohort (p¼0.084). The median number of doses received was nine, which leads to an additional cost of $846 in the Alvimopan group. If patients received the maximum number of doses (fifteen), the additional cost in the Alvimopan group was $1410. CONCLUSIONS: When utilized for patients undergoing radical cystectomy, Alvimopan seem to provide the advantage of decreased time to tolerance of regular diet, but holds no difference in time to hospital discharge and is associated with increased cost. Further prospective studies, including in-depth cost analysis, are needed to determine the most useful indication for this medication. Source of Funding: none
MP60-08 SARCOPENIA PREDICTS POSTOPERATIVE OUTCOMES FOLLOWING RADICAL CYSTECTOMY Timothy Lyon*, Nicholas Farber, Thomas Fuller, Jeffrey Gingrich, Tatum Tarin, Pittsburgh, PA INTRODUCTION AND OBJECTIVES: Sarcopenia, or the loss of skeletal muscle mass, is an indicator of overall nutritional status and can be quantified by measuring skeletal muscle volume on axial imaging. Total psoas area (TPA) has been shown to correlate with postoperative outcomes following surgery for gastrointestinal malignancies. There is limited available data supporting the relationship of TPA to outcomes following radical cystectomy. We sought to further clarify the predictive role of TPA in patients undergoing radical cystectomy for bladder cancer. METHODS: Following institutional review board approval, a retrospective chart review for all patients who underwent radical cystectomy at our institution in 2011 and 2012 was completed. TPA was measured on preoperative computed tomography (CT) scans at the L3
Vol. 191, No. 4S, Supplement, Monday, May 19, 2014
MP60-06
MP60-07
ONCOLOGICAL SAFETY AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE INTERNATIONAL ROBOTIC CYSTECTOMY CONSORTIUM
THE ROLE OF ALVIMOPAN FOR RADICAL CYSTECTOMY
Matthias Saar*, Homburg Saar, Germany; Syed Johar Raza, John Binkowski, Buffalo, NY; Lee Richstone, New York, NY; Andrew Wagner, Boston, MA; Timothy Wilson, Duarte, CA; Joan Palou Redorta, Barcelona, Spain; Prokar Dasgupta, London, United Kingdom; James Peabody, Detroit, MI; Peter Wiklund, Stockholm, Sweden; Franco Gaboardi, Milan, Italy; Alex Mottrie, Aalast, Belgium; Stephan Siemer, Homburg Saar, Germany; Raj Pruthi, Chapel Hill, NC; Alon Weizer, Ann Arbor, MI; Francis Schanne, Newark, DE; Khurshid Guru, East Amherst, NY; Koon-ho Rha, Seoul, Korea, Republic of; Ashok Hemal, Winston-Salem, NC; Douglas Scherr, New York, NY; Michael Stockle, Homburg Saar, Germany INTRODUCTION AND OBJECTIVES: Despite being performed for over a decade with satisfactory early oncologic outcomes, there are still concern regarding the induction of local recurrence and port site metastasis following Robot-assisted Radical Cystectomy (RARC). To our knowledge no major clinical study evaluating early oncological failure (EOF) with long-term follow-up has been presented regarding RARC. We attempt to assess the oncological safety of RARC with emphasis on rapid local recurrence and port site metastasis in a multiinstitutional cohort. METHODS: The IRCC database comprising of 1549 patients from 22 institutions in 13 countries performing RARC was queried for EOF. EOF was defined as any presence of rapid local spread disproportional to the primary stage within one month and any port site metastasis after surgery. Additionally the lead surgeons from each institution were contacted to confirm any reports of early failure. Each incidence was analyzed to identify common variables which may be associated with EOF. RESULTS: In the entire database of 1549 patients, EOF was reported in 8 patients (0.5%). Majority patients were males (90%) with ASA of > 3 in 75% of them. Mean age was 67 years (range 42-80 years). No inadvertent spillage of urine was reported. No major postoperative complication was noted in all of the 8 patients. All of the patients had high grade disease, with negative margins, while only 2 patients had lympho-vascular invasion on final histopathology. Additionally in the data base 3 cases of port site metastasis were reported (0.2%). All of these patients had >T2 final pathological staging, with 2/12 and 1/8 positive lympho nodes in 2 cases. Specimen retrieval was performed using the standard lap-bag, without any reported urine spillage. Mean time to port site metastasis was 4 months (range 3-6 months). 2 metastases were in isolation, while 1 case had additional lung lesions. CONCLUSIONS: Early oncological failure and port site metastasis are rare but a significant outcome after RARC. Further prospective collection of factors associated with early failure, can help in a better understanding of this rare yet significant outcome.
Source of Funding: None
e635
Zachary Hamilton*, Josh Griffin, Moben Mirza, Jeffrey Holzbeierlein, Kansas City, KS INTRODUCTION AND OBJECTIVES: Radical cystectomy is a major surgical procedure that results in delayed return of bowel function, due to primary intestinal anastomosis. Alvimopan (Entereg) is an FDA approved peripherally acting m-opiod receptor antagonist that has shown favorable results for improved recovery of gastrointestinal function and decreased hospital length of stay, including studies specifically examining radical cystectomy. We aim to retrospectively review our experience utilizing Alvimopan with patients undergoing radical cystectomy for bladder cancer. METHODS: A retrospective review was performed of patients undergoing radical cystectomy at our institution. Patients were routinely provided with Alvimopan 12mg once preoperatively and twice daily postoperatively for a maximum of seven days. At our institution, radical cystectomy patients were routinely started on a clear liquid diet on postoperative day two, and a regular diet was given after return of bowel activity, evidenced by flatus or bowel movement. Time from initiation of clear liquid diet to tolerance of regular diet was recorded, as was total length of hospitalization. An unpaired t-test was utilized for statistics. RESULTS: A total of 40 patients were given Alvimopan and 60 patients did not receive Alvimopan from July 2011 to January 2013. Mean age for the Alvimopan cohort was 67.5 years and 67.7 years in the non-Alvimopan cohort. The Alvimopan cohort contained 78% male and 22% female. The non-Alvimopan cohort contained 73.3% male and 26.7% female. The mean length of time until tolerance of regular diet in the Alvimopan cohort was 2.3 days, yet it was 3.1 days in the non-Alvimopan cohort (p¼0.036). Mean length of hospitalization for the Alvimopan cohort was 5.9 days, while it was 6.6 days in the non-Alvimopan cohort (p¼0.084). The median number of doses received was nine, which leads to an additional cost of $846 in the Alvimopan group. If patients received the maximum number of doses (fifteen), the additional cost in the Alvimopan group was $1410. CONCLUSIONS: When utilized for patients undergoing radical cystectomy, Alvimopan seem to provide the advantage of decreased time to tolerance of regular diet, but holds no difference in time to hospital discharge and is associated with increased cost. Further prospective studies, including in-depth cost analysis, are needed to determine the most useful indication for this medication. Source of Funding: none
MP60-08 SARCOPENIA PREDICTS POSTOPERATIVE OUTCOMES FOLLOWING RADICAL CYSTECTOMY Timothy Lyon*, Nicholas Farber, Thomas Fuller, Jeffrey Gingrich, Tatum Tarin, Pittsburgh, PA INTRODUCTION AND OBJECTIVES: Sarcopenia, or the loss of skeletal muscle mass, is an indicator of overall nutritional status and can be quantified by measuring skeletal muscle volume on axial imaging. Total psoas area (TPA) has been shown to correlate with postoperative outcomes following surgery for gastrointestinal malignancies. There is limited available data supporting the relationship of TPA to outcomes following radical cystectomy. We sought to further clarify the predictive role of TPA in patients undergoing radical cystectomy for bladder cancer. METHODS: Following institutional review board approval, a retrospective chart review for all patients who underwent radical cystectomy at our institution in 2011 and 2012 was completed. TPA was measured on preoperative computed tomography (CT) scans at the L3