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P043 Poor survival after laparoscopic radical nephrectomy
posters / european urology supplements 11 (2012) 191–235
blood transfusions. There was no delayed bleeding, urinary leakage or re-operation. Conclusions: Early removal of renal artery clamps during HALPNs is associated with a considerable decrease in WIT and a preservation of the kidney function estimated from eGFR. HALPN is a safe and effective treatment for carefully selected patients with small renal cell tumours, but more studies with longer observation times are needed to evaluate the renal function outcome after HALPNs. P043 Poor survival after laparoscopic radical nephrectomy C. D’elia1 , L.G. Luciani1 , T. Cai1 , G. Giusti2 , D. Tiscione1 , A. Celia3 , C. Fiori4 , F. Porpiglia4 , P. Parma5 , V. Vattovani1 , G. Malossini1 . 1 Santa Chiara Hospital, Dept. of Urology, Trento, Italy; 2 Humanitas Hospital, Dept. of Urology, Milan, Italy; 3 San Bassiano Hospital, Dept. of Urology, Bassano Del Grappa, Italy; 4 Orbassano Hospital, Dept. of Urology, Torino, Italy; 5 Carlo Poma Hospital, Dept. of Urology, Mantova, Italy Introduction & Objectives: The role of laparoscopic radical nephrectomy (LRN) for large and locally advanced primary tumors has not been clearly established. Our objective is to evaluate the oncologic outcome of LRN for large renal cell carcinoma (RCC). Material & Methods: The data of patients undergoing LRN for RCC >7 cm from 2002 to 2010 prospectively enrolled at five urologic centers in Northern Italy were reviewed. Complications were graded following the Clavien-Dindo classification. Overall survival (OS), cancer-specific survival (CSS), and progressionfree survival (PFS) were estimated using the Kaplan–Meier method. CSS estimates were adjusted for tumor stage: pT2 versus pT3. Patients were followed for a median time of 42 months (range 6–114). Results: Overall, 222 patients underwent LRN in the study period. Thirty-four cases presenting with distant metastasis were not considered: therefore, 188 of 222 patients were eligible for final follow-up analysis. Grade III or more complications and conversions occurred in 5 (2.6%) and 9 cases (4.8%), respectively. 62 (33%) cases were pT3; median tumor size was 8.5 cm (range 7–18). 5-yr overall (OS), cancer-specific (CSS), and progressionfree (PFS) survival were 74%, 78%, and 66%, respectively. 5-yr stage-adjusted CSS was 89% and 40% in pT2 and pT3 cases, respectively (p < 0.0001). The median interval to recurrence was 14 months (range 2–62). 22 of 36 patients with recurrence died of disease after a median follow-up time of 26 months. 6 (3.7%) died of unrelated disease. Conclusions: LRN for large renal tumors is efficacious, with OS and CSS rates comparable with those of open series after a medium-term follow-up time. However, patients with locally confined RCCs appear to have a remarkable survival benefit after LRN, whereas pT3 stage RCCs have a significantly lower survival. In conclusion, survival differences in locally confined or advanced pathologic stage treated by a laparoscopic approach were strongly accentuated in our series. However, these results need to be confirmed on a longer follow-up time and on larger surgical series. P044 Radiofrequency in the treatment of renal cell carcinoma: Experience in Parc Tauli Hospital J. Gual Frau, Y. Fadil Hechadi, R. Martos Calvo, J. Munoz ˜ Rodriguez, M. Barrio Munoz, ˜ C. Abad Gairin, D. Garcia Rojo, J.L. Gonzalez Sala, N. Hannaoui Hadi, A. Prera Vilaseca, E. Vicente Palacio. Corporaci´ o Sanitaria Parc Tauli, Dept. of Urology, Sabadell, Spain Introduction & Objectives: Radiofrequency ablation (RF) is a technique currently used for percutaneous treatment of renal
205
cell carcinoma, being considered one of the less invasive techniques. The indication of RF, basing on the European Guidelines of urology are one-kidney patients at risk of loss of renal function, patients with significant comorbidity and elderly patients with small lesions, asymptomatic patients with bilateral tumors and patients with genetic predisposition to develop multiple renal tumors. Material & Methods: From November 2005 to August 2011 were treated 33 suffering from renal tumor with percutaneous renal radiofrequency with an access guided by Computed Tomography (CT). To study the comorbidity we used the ASA (American Society of Anesthesiologists) scale. The radiological complete response is considered by the absence in contrast capturing. Results: Mean age 78 years (44–88), mean lesion size 2.78 cm (1–5 cm). 28 patients (84.8%) were undergone previous biopsy, 14 of whom (50%) was consistent with clear cell carcinoma, 7 chromophobe/oncocytic strokes carcinoma (25%), 4 inconclusive biopsy (14.3%) and 3 papillary carcinoma (10.7%). 2 patients ASA II (being the 2 single kidney), 12 patients ASA III, 19 patients ASA IV. Of the 33 patients, 26 (78.8%) achieved a complete response relapsed in the first month CT, 5 patients in the second treatment, and the 2 remaining in the third treatment. Therefore, all patients achieved a complete response. Complications: perirenal haematoma in 5 patients, 2 peritumoral haematoma, 1 liver laceration and 1 intracystic bleeding (requiring embolization). Conclusions: The current "gold standard" for treatment of renal lesions remains radical renal surgery with laparoscopic access. Regarding RF, the high rate of success of this minimally invasive percutaneous procedure and the low complication rate, does consider this technique as an alternative to the treatment of kidney tumor lesions, especially in older patients, patients with more surgical risk and with more comorbid conditions. P045 Laparoscopic partial nephrectomy with radiofrequency ablation B.Y. Alekseev, A.S. Kalpinskiy, K.M. Nyushko, V.A. Polyakov, N. Vorobyev, A.N. Andrianov. Moscow Hertzen Oncology Institute, Dept. of Oncourology, Moscow, Russia Introduction & Objectives: Main problems of laparoscopic partial nephrectomy (LPN) are difficulties in assessing of adequate haemostasis and necessity of renal ischemia. We present our experience of new technique of LPN with radiofrequency ablation (RFA) without ischemia comparing with standard technique of LPN. Material & Methods: LPN was performed in 122 patients in 2003–2012 in our institution. In 51 (41.8%) patients standard LPN was performed, and in 71 (58.2%) – LPN with RFA. Each procedure was performed by a single, experienced laparoscopic surgeon. A mean size of a tumor was either comparable in both groups according to CT (p > 0.05): 31.7±11.5 mm (10–60 mm) in the group of standard LPN and 28.1±11.6 mm (11–80 mm) in LPN with RFA group. All operative interventions were transperitoneal. The monopolar Cool-tip® RF system (Tyco Valleylab, USA) was used with one-needle probe (17Gauge, length 20 cm, working surface 20 mm) and a set of passive electrodes. Probe introduction was made under the ultrasound control on a assume line of a resection with setback 5–7 mm from tumor edge. The time of each RFA point was about 2 minutes and depend on tissue resistance. Neither warm nor cold renal ischemia was done. Results: Groups of patients were comparable regarding to mean operating time, median of duration of hospitalization, rate of complications and follow up time. The significant difference was observed only in median of blood loss. The median blood loss for group of standard LPN was 300 ml (50–2800) and
blood transfusions. There was no delayed bleeding, urinary leakage or re-operation. Conclusions: Early removal of renal artery clamps during HALPNs is associated with a considerable decrease in WIT and a preservation of the kidney function estimated from eGFR. HALPN is a safe and effective treatment for carefully selected patients with small renal cell tumours, but more studies with longer observation times are needed to evaluate the renal function outcome after HALPNs. P043 Poor survival after laparoscopic radical nephrectomy C. D’elia1 , L.G. Luciani1 , T. Cai1 , G. Giusti2 , D. Tiscione1 , A. Celia3 , C. Fiori4 , F. Porpiglia4 , P. Parma5 , V. Vattovani1 , G. Malossini1 . 1 Santa Chiara Hospital, Dept. of Urology, Trento, Italy; 2 Humanitas Hospital, Dept. of Urology, Milan, Italy; 3 San Bassiano Hospital, Dept. of Urology, Bassano Del Grappa, Italy; 4 Orbassano Hospital, Dept. of Urology, Torino, Italy; 5 Carlo Poma Hospital, Dept. of Urology, Mantova, Italy Introduction & Objectives: The role of laparoscopic radical nephrectomy (LRN) for large and locally advanced primary tumors has not been clearly established. Our objective is to evaluate the oncologic outcome of LRN for large renal cell carcinoma (RCC). Material & Methods: The data of patients undergoing LRN for RCC >7 cm from 2002 to 2010 prospectively enrolled at five urologic centers in Northern Italy were reviewed. Complications were graded following the Clavien-Dindo classification. Overall survival (OS), cancer-specific survival (CSS), and progressionfree survival (PFS) were estimated using the Kaplan–Meier method. CSS estimates were adjusted for tumor stage: pT2 versus pT3. Patients were followed for a median time of 42 months (range 6–114). Results: Overall, 222 patients underwent LRN in the study period. Thirty-four cases presenting with distant metastasis were not considered: therefore, 188 of 222 patients were eligible for final follow-up analysis. Grade III or more complications and conversions occurred in 5 (2.6%) and 9 cases (4.8%), respectively. 62 (33%) cases were pT3; median tumor size was 8.5 cm (range 7–18). 5-yr overall (OS), cancer-specific (CSS), and progressionfree (PFS) survival were 74%, 78%, and 66%, respectively. 5-yr stage-adjusted CSS was 89% and 40% in pT2 and pT3 cases, respectively (p < 0.0001). The median interval to recurrence was 14 months (range 2–62). 22 of 36 patients with recurrence died of disease after a median follow-up time of 26 months. 6 (3.7%) died of unrelated disease. Conclusions: LRN for large renal tumors is efficacious, with OS and CSS rates comparable with those of open series after a medium-term follow-up time. However, patients with locally confined RCCs appear to have a remarkable survival benefit after LRN, whereas pT3 stage RCCs have a significantly lower survival. In conclusion, survival differences in locally confined or advanced pathologic stage treated by a laparoscopic approach were strongly accentuated in our series. However, these results need to be confirmed on a longer follow-up time and on larger surgical series. P044 Radiofrequency in the treatment of renal cell carcinoma: Experience in Parc Tauli Hospital J. Gual Frau, Y. Fadil Hechadi, R. Martos Calvo, J. Munoz ˜ Rodriguez, M. Barrio Munoz, ˜ C. Abad Gairin, D. Garcia Rojo, J.L. Gonzalez Sala, N. Hannaoui Hadi, A. Prera Vilaseca, E. Vicente Palacio. Corporaci´ o Sanitaria Parc Tauli, Dept. of Urology, Sabadell, Spain Introduction & Objectives: Radiofrequency ablation (RF) is a technique currently used for percutaneous treatment of renal
205
cell carcinoma, being considered one of the less invasive techniques. The indication of RF, basing on the European Guidelines of urology are one-kidney patients at risk of loss of renal function, patients with significant comorbidity and elderly patients with small lesions, asymptomatic patients with bilateral tumors and patients with genetic predisposition to develop multiple renal tumors. Material & Methods: From November 2005 to August 2011 were treated 33 suffering from renal tumor with percutaneous renal radiofrequency with an access guided by Computed Tomography (CT). To study the comorbidity we used the ASA (American Society of Anesthesiologists) scale. The radiological complete response is considered by the absence in contrast capturing. Results: Mean age 78 years (44–88), mean lesion size 2.78 cm (1–5 cm). 28 patients (84.8%) were undergone previous biopsy, 14 of whom (50%) was consistent with clear cell carcinoma, 7 chromophobe/oncocytic strokes carcinoma (25%), 4 inconclusive biopsy (14.3%) and 3 papillary carcinoma (10.7%). 2 patients ASA II (being the 2 single kidney), 12 patients ASA III, 19 patients ASA IV. Of the 33 patients, 26 (78.8%) achieved a complete response relapsed in the first month CT, 5 patients in the second treatment, and the 2 remaining in the third treatment. Therefore, all patients achieved a complete response. Complications: perirenal haematoma in 5 patients, 2 peritumoral haematoma, 1 liver laceration and 1 intracystic bleeding (requiring embolization). Conclusions: The current "gold standard" for treatment of renal lesions remains radical renal surgery with laparoscopic access. Regarding RF, the high rate of success of this minimally invasive percutaneous procedure and the low complication rate, does consider this technique as an alternative to the treatment of kidney tumor lesions, especially in older patients, patients with more surgical risk and with more comorbid conditions. P045 Laparoscopic partial nephrectomy with radiofrequency ablation B.Y. Alekseev, A.S. Kalpinskiy, K.M. Nyushko, V.A. Polyakov, N. Vorobyev, A.N. Andrianov. Moscow Hertzen Oncology Institute, Dept. of Oncourology, Moscow, Russia Introduction & Objectives: Main problems of laparoscopic partial nephrectomy (LPN) are difficulties in assessing of adequate haemostasis and necessity of renal ischemia. We present our experience of new technique of LPN with radiofrequency ablation (RFA) without ischemia comparing with standard technique of LPN. Material & Methods: LPN was performed in 122 patients in 2003–2012 in our institution. In 51 (41.8%) patients standard LPN was performed, and in 71 (58.2%) – LPN with RFA. Each procedure was performed by a single, experienced laparoscopic surgeon. A mean size of a tumor was either comparable in both groups according to CT (p > 0.05): 31.7±11.5 mm (10–60 mm) in the group of standard LPN and 28.1±11.6 mm (11–80 mm) in LPN with RFA group. All operative interventions were transperitoneal. The monopolar Cool-tip® RF system (Tyco Valleylab, USA) was used with one-needle probe (17Gauge, length 20 cm, working surface 20 mm) and a set of passive electrodes. Probe introduction was made under the ultrasound control on a assume line of a resection with setback 5–7 mm from tumor edge. The time of each RFA point was about 2 minutes and depend on tissue resistance. Neither warm nor cold renal ischemia was done. Results: Groups of patients were comparable regarding to mean operating time, median of duration of hospitalization, rate of complications and follow up time. The significant difference was observed only in median of blood loss. The median blood loss for group of standard LPN was 300 ml (50–2800) and