Brent Yanke

Impact of Body Mass Index on Survival of Patients With Surgically Treated Renal Cell Carcinoma

PURPOSE Population studies link increased BMI with an increased risk of cancer and cancer mortality and in particular a greater risk of RCC. We evaluated the impact of BMI and other clinical/pathological characteristics on survival in patients with RCC treated with radical or partial nephrectomy. MATERIALS AND METHODS Between 1995 and 2003 patients undergoing radical (760) or partial (399) nephrectomy for RCC were entered into a database. BMI data were available on 1,137 of 1,159 (98%). Demographic and clinical/pathological parameters were analyzed. World Health Organization BMI definitions (normal-less than 25 kg/m(2), overweight-25 to 29.9 kg/m(2), obese-30 kg/m(2) or more) were used. RESULTS A total of 75% of patients had greater than normal BMI with 472 (41.5%) overweight and 387 (34.0%) obese. Median followup was 33 months with a median overall survival of 110 months and a 5-year overall survival probability of 0.79. BMI categories were similar in age, gender, smoking status, presenting symptoms, tumor size, stage, and type of surgery. Significant increases in blood loss and operative time (p <0.05) were seen with increasing BMI. Although BMI 30 kg/m(2) or greater was associated with a higher proportion of clear cell histology (p = 0.002), it did not translate into an increased pathological stage, or incidence of metastasis. Multivariate analysis revealed age older than 65 years, systemic symptoms, surgery type, and pathological stage impacted overall survival (p <0.05). CONCLUSIONS Although an increased BMI was associated with a greater proportion of clear cell histology, comorbidity, and surgical morbidity, BMI did not adversely impact overall or progression-free survival.

MP27-13 RANDOMIZED STUDY OF GREENLIGHT XPS LASER VS BIPOLAR VAPORIZATION ELECTRODE (BIVAP) SALINE VAPORIZATION OF THE PROSTATE IN MEN WITH SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA (BPH)

INTRODUCTION AND OBJECTIVES: As per Goliath trial, Greenlight laser (XPS) Photoselective Vaporization of the prostate (GL.PVP) is non-inferior to TURP in reduction of LUTs secondary to BPH with all advantages of laser. Plasma Kinetic vaporization of the prostate (PKVP) is a potential contender to the evolving Greenlight PVP. In this study, non-inferiority of PKVP compared to GL.PVP, in reduction of LUTS secondary to BPH, was tested in a randomized trial. METHODS: Between November 2014 and October 2015, 120 patients with complicated BPH (size 30-80 cc) were randomized to GL.PVP and PKVP.Patients were assessed postoperatively using I-PSS, QOL, Qmax and PVR (at 1, 4, and 12 months), IIEF-15 and PSA (at 4 and 12 months). Non-inferiority of I-PSS at 1 year was evaluated using a 1-sided test at 5% level of significance. The statistical significance of other comparators was assessed at the (2-sided) 5% level. RESULTS: At time of analysis 58 GL.PVP and 61 PKVP procedures were included. Patients’ demographics, prostate size, indications of intervention and perioperative parameters were comparable between both groups apart from more perioperative irrigant fluid use in GL.PVP (P 1⁄40.014). More postoperative dysuria was reported after PKVP, dysuria visual analogue scale 4(0-10) vs. 6(0-10), P1⁄40.005 in GL.PVP and PKVP respectively. Urinary outcome measures revealed significant comparable improvement in both groups at different follow up points either in the net value or in the percentage improvement from baseline measure. At 1 year, median IPSS was 6 (1:25) vs 5 (1:18) P1⁄40.7, median QoL was 1 (0:5) vs 1 (1:5) P1⁄40.84, mean Q max was 22 9.4 vs 20 8.5 ml/sec P1⁄40.42, median PVR was 20 (0:97) vs 25 (0:109) ml P1⁄40.14, in GL.PVP and PKVP respectively. Median postoperative change in PSA was 63.5% (-54:95) following GL.PVP vs 31.6% (-66:30) after PKVP, P1⁄40.027. Both groups showed comparable perioperative and late postoperative complication and re-intervention rate during the first year. Among sexually active men (25%), there was significant reduction of IIEF-15 score following PKVP in comparison to GL.PVP CONCLUSIONS: PKVP is a safe and effective modality in treating patients with LUTS secondary to small to moderate sized BPH. In terms of symptoms control, it was not inferior to GL.PVP at 1 year. Long-term durability of the outcome is critical considering the difference in postoperative PSA reduction. Impact on the sexual function should be considered for further evaluation in a larger cohort of sexually active men.

799: The Safety of the Veress Needle in Pediatric Laparoscopy

PURPOSE To better establish the complication rate with the Veress needle technique for establishing a pneumoperitoneum in pediatric laparoscopy. PATIENTS AND METHODS We reviewed all pediatric laparoscopy cases performed by a single surgeon from 1996 to 2003. There were 257 patients ranging in age from 4 months to 19 years. Infraumbilical placement of the Veress needle was used to create a pneumoperitoneum. All instances of preperitoneal insufflation, vessel/viscus injury, and forced conversion to open surgery were recorded. The length of time required to establish pneumoperitoneum was reported in the last 139 patients. RESULTS The average length of time required to gain access to the peritoneum was <2 minutes. Of these procedures, 138 were performed for nonpalpable undescended testicles, 101 for varicoceles, 13 for duplication anomalies, and 5 for intersex disorders. There were 18 cases (7.0%) of preperitoneal insufflation. No cases resulted in vessel/visceral injury, conversion to open surgery, conversion to use of the Hassan trocar technique, or inability to complete the procedure because of complications in establishing a pneumoperitoneum. In all cases of preperitoneal insufflation, proper access was achieved by pulling the needle out and reinserting it at a different angle, with pneumoperitoneum being achieved easily in each case. CONCLUSION The use of the Veress needle to establish pneumoperitoneum in children of all ages is safe, fast, and efficacious.