Mario Sodano

TriMatch comparison of the efficacy of FloSeal versus TachoSil versus no hemostatic agents for partial nephrectomy: Results from a large multicenter dataset

To evaluate the efficacy of hemostatic agents, TachoSil and FloSeal, during partial nephrectomy using a large multicenter dataset.

A snapshot of nephron-sparing surgery in Italy: A prospective, multicenter report on clinical and perioperative outcomes (the RECORd 1 project)

INTRODUCTION Nephron-sparing surgery (NSS) has become the standard of care for the surgical management of small and clinically localized renal cell carcinoma (RCC). The conservative management of those RCCs is increasing over time. Aim of this study was to report a snapshot of the clinical, perioperative and oncological results after NSS for RCC in Italy. MATERIAL AND METHODS We evaluated all patients who underwent conservative surgical treatment for renal tumours between January 2009 and December 2012 at 19 urological Italian Centers (RECORd project). Perioperative, radiological and histopathological data were recorded. Surgical eras (2009 vs 2012 and year periods 2009-2010 vs 2011-2012) were compared. RESULTS Globally, 983 patients were evaluated. More recently, patients undergoing NSS were found to be significantly younger (p = 0.05) than those surgically treated in the first study period, with a significantly higher rate of NSS with relative and imperative indication (p < 0.001). More recently, a higher percentage of procedures for cT1b or cT2 renal tumours was observed (p = 0.02). Utilization rate of open partial nephrectomy (OPN) constantly decreased during years, laparoscopic partial nephrectomy (LPN) remained almost constant while robot-assisted partial nephrectomy (RAPN) increased. The rate of clampless NSS constantly increased over time. The use of at least one haemostatic agent has been significantly more adopted in the most recent surgical era (p < 0.001). CONCLUSIONS The utilization rate of NSS in Italy is increasing, even in elective and more complex cases. RAPN has been progressively adopted, as well as the intraoperative utilization of haemostatic agents and the rate of clampless procedures.

A Prospective, Multicenter Evaluation of Predictive Factors for Positive Surgical Margins After Nephron-Sparing Surgery for Renal Cell Carcinoma: The RECORd1 Italian Project

BACKGROUND The purpose of this study was to evaluate the predictors of positive margins in one of the largest available prospective multi-institutional studies. PATIENTS AND METHODS We evaluated all patients who underwent NSS for radiologically diagnosed kidney tumors between January 2009 and December 2012 at 19 urological Italian centers (Registry of Conservative Renal Surgery [RECORd] project). Preoperative and anthropometric data, comorbidities, intraoperative and postoperative outcomes, and histological findings were analyzed. The negative and PSMs were compared according to the clinical and surgical variables. Multivariable logistic regression models were applied to analyze predictors of PSMs. RESULTS Eight hundred consecutive patients were evaluated. Seven hundred sixty-one (95.1%) and 39 patients (4.9%) achieved negative and PSMs, respectively. Patients with PSMs were significantly older compared with those with negative margins (median age: 66.6 vs. 61.8 years, respectively; P = .001). A higher incidence of PSMs was observed when NSS was performed for renal masses located in the upper pole (P = .001). A lower rate of PSMs was found in patients treated with simple enucleation rather than standard PN (1.6% vs. 7.4%, respectively; P < .0001). A greater incidence of PSMs was found in Fuhrman 3/4 tumors (11.3%; P < .0001). At multivariable analysis, age (odds ratio [OR], 1.04; P = .01), upper pole tumor location (OR, 2.85; P = .005), standard PN (OR, 3.45; P = .004), and Fuhrman 3-4 nuclear grade (OR, 4.81; P = .001) were found to be independent predictors of PSMs. CONCLUSION In our multi-institutional report, young age, simple enucleation, middle or lower tumor location, and low-grade tumor were demonstrated to be independent predictors of negative SMs.

Venous tumor thrombus consistency is not predictive of survival in patients with renal cell carcinoma: A retrospective study of 147 patients.

To evaluate the prognostic role of venous tumor thrombus consistency in patients with renal cell carcinoma.

Features, risk factors and clinical outcome of “very late” recurrences after surgery for localized renal carcinoma: A retrospective evaluation of a cohort with a minimum of 10 years of follow up

To evaluate the features and the predictors of “very late” recurrences after surgery for localized renal cell carcinoma.

Features of Ipsilateral Renal Recurrences After Partial Nephrectomy: A Proposal of A Pathogenetic Classification

Micro‐Abstract This report concerns renal cell carcinoma: we investigate features of ipsilateral relapse after nephron‐sparing surgery. This topic is poorly investigated in the literature, in particular if relapse could be related to a persistence of the primary tumor or to a newborn one. We analyzed 18 cases of relapse after partial nephrectomy subsequently submitted to salvage nephrectomy. After revision of the anatomical specimens we found 3 types of relapse related to different etiology, histology, and mostly to different prognosis. Background: Poor data are reported on the pathogenesis of ipsilateral relapse (IR) after partial nephrectomy (PN). The objective of this study was to investigate features of IR after PN with the intention to propose a pathogenetic classification. Materials and Methods: Retrospective consultation of an institutional database that stores the data of 683 patients submitted to PN since 1993. The clinical, radiological, and follow‐up data of the cases submitted to salvage nephrectomy due to an IR were analyzed. The slides of the sections from the tumor‐parenchyma interface of PN and the bed of resection from the specimen of nephrectomy were reviewed. Results: Eighteen patients were submitted to salvage nephrectomy for an IR. In 12 cases the IR harbored into the site of PN and a mixture of cancer cells and granulomatous reaction was found at the resection bed (IR type A). In the remaining 6, in microscopy of the resection bed was found only fibrosis: 3 of these cases had a clear‐cell renal cell carcinoma (RCC) with diffuse microvascular embolization and the relapse in the same portion of the kidney of the primary tumor (IR type B); the other 3 had a non–clear‐cell RCC and the primary and relapsing tumors were located in distinct portions of the kidney (IR type C). Six patients (4 IR type A, 2 type B) had a further progression and 5 of them died due to RCC. Conclusion: More frequently an IR is due to the incomplete resection of the primary tumor (IR type A), in a minority of the cases to the local spread of the tumor by microvascular embolization (IR type B), or true multifocality (IR type C). The prognosis of IR not due to multifocality (type A and B) is poor, despite salvage nephrectomy.

MP97-05 OUTCOMES OF PREVENTIVE VS DELAYED LIGATION OF DORSAL VASCULAR COMPLEX DURING RARP: PRELIMINARY RESULTS OF A RANDOMIZED TRIAL

INTRODUCTION AND OBJECTIVES: Little glucose metabolism is generally thought to occur in prostate cancer, leading to low diagnostic accuracy of 18F-fluoro-2-deoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT). Nevertheless, this modality is reportedly useful for identifying high-risk local cancers. We therefore investigated whether local FDG uptake by the prostate reflects the perioperative results of robot-assisted laparoscopic radical prostatectomy (RALP). METHODS: Between November 2012 and August 2016, a total of 248 patients underwent RALP at our institution. Of these, subjects in this study comprised 116 patients in whom FDG-PET/CT was employed for preoperative staging. We retrospectively compared perioperative results between patients, stratified for local FDG uptake in the prostate. Patients who had received preoperative hormone therapy were excluded from the study. FDG uptake was rated based on clinical reports prepared by two radiation diagnosticians. Patient background characteristics, perioperative results and postoperative pathological results were compared between subjects divided into PET-positive and -negative groups. RESULTS: Participants comprised 40 PET-positive subjects and 76 PET-negative subjects. Among the patient background characteristics, mean age was slightly but significantly higher in the PETpositive group (66 years) than in the PET-negative group (64 years; p1⁄40.0485). No significant differences were seen in PSA level, clinical T stage or Gleason Score (GS). Operative time, console time and volume of blood loss also showed no differences between groups, and no patients in either group suffered rectal perforation or required blood transfusion. Postoperative urethral balloon retention time and urinary continence rate at 3 months postoperatively were comparable between groups. Postoperative pathological results showed significantly higher values for the following parameters in the PET-positive group than in the PET-negative group: extraprostatic invasion (45.0% vs 22.4%; p1⁄40.0185); positive margin (30.0% vs 13.2%; p1⁄40.0445); and GS 1⁄48 (52.5% vs 23.7%; p1⁄40.00343). Multivariate analysis also showed that PET positivity tended to be associated with positive margins (odds ratio (OR), 2.45; p1⁄40.0819) and extraprostatic invasion (OR, 2.34; p1⁄40.0529), while GS 1⁄48 was a significant predictor (OR, 3.08; p1⁄40.0208). CONCLUSIONS: In RALP, FDG uptake should be considered a predictor of high-grade disease and a risk factor for positive margins.

External Validation of the Arterial-Based Complexity Score and First Head-to-Head Comparison With the R.E.N.A.L. and PADUA Scores and C-index

&NA; The aim of the present study was to prove the arterial‐based complexity (ABC) score validity by comparing it with the R.E.N.A.L. (radius, exophytic/endophytic tumor properties, nearness of tumor to deepest portion of collecting system or sinus, anterior/posterior descriptor, location relative to the polar line), PADUA (preoperative aspects and dimension for anatomic classification of renal tumors), and C‐index scores. We performed a retrospective analysis of pre‐ and postoperative data from 234 patients who had undergone open and robot‐assisted partial nephrectomy. An external urologist who was unaware of the outcomes reviewed all computed tomography scans to assign the nephrometry scores and determine tumor complexity. We found no statistically significant superiority for the ABC system. Introduction: We performed an external validation of the arterial‐based complexity (ABC) score using a head‐to‐head comparison with the R.E.N.A.L. (radius, exophytic/endophytic tumor properties, nearness of tumor to deepest portion of collecting system or sinus, anterior/posterior descriptor, location relative to the polar line), PADUA (preoperative aspects and dimension for anatomic classification of renal tumors), and C‐index scores for the prediction of surgical outcomes after partial nephrectomy. Materials and Methods: The data from a series of consecutive open or robot‐assisted partial nephrectomies performed from January 2014 to July 2016 by 4 expert surgeons at a tertiary academic institution were reviewed. After dedicated training, 1 urologist not involved in the surgical procedures evaluated the cross‐sectional imaging studies and assigned the nephrometry score using the 4 nephrometry scoring systems. The predictive performance of the ABC and other scoring systems was tested in univariate and multivariable fashion. Results: Overall, 234 patients were recruited (148 men and 86 women; age, 63 ± 10.9 years). The scores were all related to the estimated blood loss, use of hilar clamping, ischemia time, operative time, length of stay, and MIC (margin status, ischemia time, complications) score. They were not related to the occurrence of postoperative complications or, for the C‐index and ABC score, the length of stay. In a head‐to‐head comparison, the ABC was not inferior only to the C‐index relative to the occurrence of complications and MIC score, with borderline statistical significance. On multivariate analysis, the ABC score provided significant improvement only for the prediction of the operative and ischemia times. However, its performance was inferior to that of the other scoring systems. In addition, only the PADUA score improved the prediction of artery clamping and MIC score, and only the R.E.N.A.L. score showed an advantage for the prediction of the estimated blood loss. Conclusion: The predictive ability of ABC was inferior to that of well‐established existing nephrometry scoring systems, such as the PADUA and R.E.N.A.L. scores.

MP41-12 DISCRIMINATION ABILITY OF THE SURFACE-INTERMEDIATE-BASE MARGIN (SIB) SCORE: AN EXTERNAL HISTOPATHOLOGICAL EVALUATION

Andrea Minervini, Riccardo Campi, Andrea Mari, Florence, Italy; Ottavio DeCobelli, Milan, Italy; Francesco Sanguedolce, Bristol, United Kingdom; Georgios Hatzichristodoulou, Munich, Germany; Alessandro Antonelli, Brescia, Italy; Brian Lane, Grand Rapids, MI; Bulent Akdogan, Munich, Germany; Umberto Capitanio, Milan, Italy; Martin Marszalek, Vienna, Austria; Alessandro Volpe, Novara, Italy; Nihat Karakoyunlu, Ankara, Turkey; Hans Langenhuijsen, Nijmegen, Netherlands; Tobias Klatte, Vienna, Austria; Oscar Rodriguez-Faba, Barcelona, Spain; Miki Haifler, Philadelphia, PA; Sabine BrookmanMay, Munich, Germany; Marco Roscigno, Bergamo, Italy; Robert Uzzo, Philadelphia, PA; Marco Carini, Florence, Italy; Alexander Kutikov*, Philadelphia, PA