- Email: [email protected]
MP81-17 ORCHIECTOMY FOLLOWING MICROSURGICAL DENERVATION OF THE SPERMATIC CORD: SINGLE INSTITUTION REVIEW
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
(31% vs 11% vs 7%; p¼0.005). Patients with an altered TP53/MDM2 pathway had significantly shorter progression-free survival. TP53/MDM2 alteration was an independent predictor of progression (HR 2.89, 95% CI 1.66 to 5.02, p< 0.001) in a multivariable analysis that included IGCCCG risk group. CONCLUSIONS: The increased frequency of TP53 pathway alterations amongst patients with IGCCCG poor-risk disease and the association of these alterations with shorter progression free survival independent of IGCCCG risk, support routine genomic profiling of patients with aGCTs to enhance risk stratification and possibly identify patients for novel treatment strategies. Table 1 Patient Characteristics (Discovery and Validation Cohorts)
e1059
primary RA-RPLND compared to 33 (32%) patients who received previous chemotherapy. Mean operative time was 339 min (SD 108). Estimated blood loss was 244.1 ml (SD 486). Length of postoperative hospital stay was 2.1 days (SD 1.5). There were six conversions (5.8%) to open RPLND. Postoperatively, there were 28 total complications (Grade I¼22, II¼5, IIIB¼1). From oncological point of view, mean lymph node (LN) yield was 24.1 LNs (SD 10.8) with positive LN identified in 35 patients (33.9%). Among the primary RARPLND, adjuvant chemotherapy was given to 21.4% (3/14) of pIIA, 50% (3/6) of pIIB and 50% of pIIC patients. There were five lung recurrences (4.8%) identified at a mean follow up of 26.9 months (SD 22.4). No in field recurrences were identified CONCLUSIONS: To our knowledge this study represents the largest study of RA-RPLND outcomes in testicular cancer patients. It demonstrates that this procedure is safe and reproducible.
Variable
All Patients (n¼120)
Sensitive (n¼44)
Resistant (n¼76)
Median Age (Range)
29.7 (16.0 e 65.1)
31.0 (16.0 e 65.1)
29.4 (18.2 e 58.3)
NSGCT
92 (76.7%)
28 (63.6%)
64 (84.2%)
Seminoma
28 (23.3%)
16 (36.4%)
12 (15.8%)
Testis
106 (88.3%)
42 (95.5%)
64 (84.2%)
MP81-17
Mediastinum
14 (11.7%)
2 (4.5%)
12 (15.8%)
ORCHIECTOMY FOLLOWING MICROSURGICAL DENERVATION OF THE SPERMATIC CORD: SINGLE INSTITUTION REVIEW
Good
56(46.7%)
30 (68.2%)
26 (34.2%)
Kathryn Lipscomb*, Daniel Williams IV, Madison, WI
Intermediate
19 (15.8%)
9 (20.5%)
10 (13.2%)
Poor
45 (37.5%)
5 (11.4%)
40 (52.6%)
39 (51.3%)
Histology
Source of Funding: None
Primary site
IGCCCG
Initial Chemo BEP
50 (41.7%)
11 (25%)
EP
44 (36.7%)
25 (56.8%)
19 (25%)
TIP or VIP
26 (21.7%)
8 (18.2%)
18 (23.7%)
Primary
50 (41.7)
40 (90.9)
30 (39.5)
Metastasis
70 (58.3)
4 (9.1)
46 (60.5)
Sample Type
Sample collection Pre-chemotherapy
70 (58.3%)
44(100%)
26 (34.2%)
Postchemotherapy
50 (41.7%)
0 (0%)
50 (65.8%)
Died of Disease
17 (14.2%)
0 (0%)
17 (22.3%)
Source of Funding: Urology Care Foundation Research Scholars Program
MP81-16 PERIOPERATIVE AND EARLY ONCOLOGICAL OUTCOMES FOLLOWING ROBOT ASSISTED RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTICULAR CANCER: A MULTI-INSTITUTIONAL STUDY Haidar Abdul-Muhsin*, Phoenix, AZ; Michael Marshall, Sean Stroup, James L’esperance, San Diego, CA; Michael Woods, Chapel Hill, NC; James Porter, Seattle, WA; Erik Castle, Phoenix, AZ INTRODUCTION AND OBJECTIVES: To evaluate the perioperative outcomes and postoperative complication rates for robot assisted retroperitoneal lymph node dissection (RA-RPLND) in a large multi-Institutional cohort. METHODS: After individual institutional review board approval in four participating institutions, the data of all testicular cancer patients treated with RA-RPLND at these tertiary institutions were collected and retrospectively analyzed. The procedures were performed by a single robotic surgeon at each participating institution. All demographic, Intraoperative variables, post-operative pathological outcomes and complications were reported. Additionally, Recurrence rates were reported at then end of follow up. RESULTS: There were 103 patients who underwent RA-RPLND. The mean patients age was 29.6 years (SD 9.7), mean BMI was 26.4 Kg/m2 (SD 5.1). Bilateral Full template dissection was performed in 65 (63.1%) patients compared to 36 patients (35%) who had modified templates of dissection. Nerve sparing was attempted in 68 (66%) patients. There were 70 (68%) patients who underwent
INTRODUCTION AND OBJECTIVES: Chronic scrotal content pain can be a debilitating condition for patients and a challenge for urologists to treat. In the absence of physical findings to explain scrotal content pain, microsurgical denervation of the spermatic cord (MDSC) can be an effective testis-sparing treatment when symptoms are refractory to medical therapy. Success rates for MDSC have been reported when performed after other attempted surgical treatments. However, no data exists on the rate and efficacy of orchiectomy following MDSC for recurrent or persistent pain. METHODS: A retrospective chart review was performed. Data collected included basic demographics, side(s) denervated, symptomatic improvement, time to follow up, current symptomatology, and any ongoing treatments. Charts of patients undergoing subsequent orchiectomy were further examined for symptomatic improvement following orchiectomy. RESULTS: We identified 124 patients with 134 testes treated with MDSC. Median age at time of presentation was 45. Follow-up ranged from 3 to 88 months with mean of 37.7 months. 10 radical inguinal orchiectomies (8% of patients, 7.4% sides treated) were performed for recurrent or persistent scrotal content pain following MDSC. Time to orchiectomy ranged from 1 to 32 months with an average of 13.8 months. 11 of 124 patients (8%) underwent bilateral MDSC, and 4 of these patients ultimately underwent unilateral orchiectomy. One patient is pending completion of bilateral orchiectomy. Of the 10 orchiectomies, 7 patients reported complete resolution of pain, 2 patients remain on narcotics for pain control, and 1 patient remains on gabapentin. CONCLUSIONS: Following MDSC, 8% of our patients underwent orchiectomy for recurrent or persistent scrotal content pain, and two-thirds of them reported complete resolution of their pain following orchiectomy. Men with bilateral scrotal content pain were at a greater risk of progressing to orchiectomy following MDSC. Knowing the rate of, time to, and efficacy of orchiectomy after MDSC can help providers counsel patients about and set expectations for the outcomes of these procedures. Source of Funding: NONE
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
(31% vs 11% vs 7%; p¼0.005). Patients with an altered TP53/MDM2 pathway had significantly shorter progression-free survival. TP53/MDM2 alteration was an independent predictor of progression (HR 2.89, 95% CI 1.66 to 5.02, p< 0.001) in a multivariable analysis that included IGCCCG risk group. CONCLUSIONS: The increased frequency of TP53 pathway alterations amongst patients with IGCCCG poor-risk disease and the association of these alterations with shorter progression free survival independent of IGCCCG risk, support routine genomic profiling of patients with aGCTs to enhance risk stratification and possibly identify patients for novel treatment strategies. Table 1 Patient Characteristics (Discovery and Validation Cohorts)
e1059
primary RA-RPLND compared to 33 (32%) patients who received previous chemotherapy. Mean operative time was 339 min (SD 108). Estimated blood loss was 244.1 ml (SD 486). Length of postoperative hospital stay was 2.1 days (SD 1.5). There were six conversions (5.8%) to open RPLND. Postoperatively, there were 28 total complications (Grade I¼22, II¼5, IIIB¼1). From oncological point of view, mean lymph node (LN) yield was 24.1 LNs (SD 10.8) with positive LN identified in 35 patients (33.9%). Among the primary RARPLND, adjuvant chemotherapy was given to 21.4% (3/14) of pIIA, 50% (3/6) of pIIB and 50% of pIIC patients. There were five lung recurrences (4.8%) identified at a mean follow up of 26.9 months (SD 22.4). No in field recurrences were identified CONCLUSIONS: To our knowledge this study represents the largest study of RA-RPLND outcomes in testicular cancer patients. It demonstrates that this procedure is safe and reproducible.
Variable
All Patients (n¼120)
Sensitive (n¼44)
Resistant (n¼76)
Median Age (Range)
29.7 (16.0 e 65.1)
31.0 (16.0 e 65.1)
29.4 (18.2 e 58.3)
NSGCT
92 (76.7%)
28 (63.6%)
64 (84.2%)
Seminoma
28 (23.3%)
16 (36.4%)
12 (15.8%)
Testis
106 (88.3%)
42 (95.5%)
64 (84.2%)
MP81-17
Mediastinum
14 (11.7%)
2 (4.5%)
12 (15.8%)
ORCHIECTOMY FOLLOWING MICROSURGICAL DENERVATION OF THE SPERMATIC CORD: SINGLE INSTITUTION REVIEW
Good
56(46.7%)
30 (68.2%)
26 (34.2%)
Kathryn Lipscomb*, Daniel Williams IV, Madison, WI
Intermediate
19 (15.8%)
9 (20.5%)
10 (13.2%)
Poor
45 (37.5%)
5 (11.4%)
40 (52.6%)
39 (51.3%)
Histology
Source of Funding: None
Primary site
IGCCCG
Initial Chemo BEP
50 (41.7%)
11 (25%)
EP
44 (36.7%)
25 (56.8%)
19 (25%)
TIP or VIP
26 (21.7%)
8 (18.2%)
18 (23.7%)
Primary
50 (41.7)
40 (90.9)
30 (39.5)
Metastasis
70 (58.3)
4 (9.1)
46 (60.5)
Sample Type
Sample collection Pre-chemotherapy
70 (58.3%)
44(100%)
26 (34.2%)
Postchemotherapy
50 (41.7%)
0 (0%)
50 (65.8%)
Died of Disease
17 (14.2%)
0 (0%)
17 (22.3%)
Source of Funding: Urology Care Foundation Research Scholars Program
MP81-16 PERIOPERATIVE AND EARLY ONCOLOGICAL OUTCOMES FOLLOWING ROBOT ASSISTED RETROPERITONEAL LYMPH NODE DISSECTION FOR TESTICULAR CANCER: A MULTI-INSTITUTIONAL STUDY Haidar Abdul-Muhsin*, Phoenix, AZ; Michael Marshall, Sean Stroup, James L’esperance, San Diego, CA; Michael Woods, Chapel Hill, NC; James Porter, Seattle, WA; Erik Castle, Phoenix, AZ INTRODUCTION AND OBJECTIVES: To evaluate the perioperative outcomes and postoperative complication rates for robot assisted retroperitoneal lymph node dissection (RA-RPLND) in a large multi-Institutional cohort. METHODS: After individual institutional review board approval in four participating institutions, the data of all testicular cancer patients treated with RA-RPLND at these tertiary institutions were collected and retrospectively analyzed. The procedures were performed by a single robotic surgeon at each participating institution. All demographic, Intraoperative variables, post-operative pathological outcomes and complications were reported. Additionally, Recurrence rates were reported at then end of follow up. RESULTS: There were 103 patients who underwent RA-RPLND. The mean patients age was 29.6 years (SD 9.7), mean BMI was 26.4 Kg/m2 (SD 5.1). Bilateral Full template dissection was performed in 65 (63.1%) patients compared to 36 patients (35%) who had modified templates of dissection. Nerve sparing was attempted in 68 (66%) patients. There were 70 (68%) patients who underwent
INTRODUCTION AND OBJECTIVES: Chronic scrotal content pain can be a debilitating condition for patients and a challenge for urologists to treat. In the absence of physical findings to explain scrotal content pain, microsurgical denervation of the spermatic cord (MDSC) can be an effective testis-sparing treatment when symptoms are refractory to medical therapy. Success rates for MDSC have been reported when performed after other attempted surgical treatments. However, no data exists on the rate and efficacy of orchiectomy following MDSC for recurrent or persistent pain. METHODS: A retrospective chart review was performed. Data collected included basic demographics, side(s) denervated, symptomatic improvement, time to follow up, current symptomatology, and any ongoing treatments. Charts of patients undergoing subsequent orchiectomy were further examined for symptomatic improvement following orchiectomy. RESULTS: We identified 124 patients with 134 testes treated with MDSC. Median age at time of presentation was 45. Follow-up ranged from 3 to 88 months with mean of 37.7 months. 10 radical inguinal orchiectomies (8% of patients, 7.4% sides treated) were performed for recurrent or persistent scrotal content pain following MDSC. Time to orchiectomy ranged from 1 to 32 months with an average of 13.8 months. 11 of 124 patients (8%) underwent bilateral MDSC, and 4 of these patients ultimately underwent unilateral orchiectomy. One patient is pending completion of bilateral orchiectomy. Of the 10 orchiectomies, 7 patients reported complete resolution of pain, 2 patients remain on narcotics for pain control, and 1 patient remains on gabapentin. CONCLUSIONS: Following MDSC, 8% of our patients underwent orchiectomy for recurrent or persistent scrotal content pain, and two-thirds of them reported complete resolution of their pain following orchiectomy. Men with bilateral scrotal content pain were at a greater risk of progressing to orchiectomy following MDSC. Knowing the rate of, time to, and efficacy of orchiectomy after MDSC can help providers counsel patients about and set expectations for the outcomes of these procedures. Source of Funding: NONE