Pd43-04 management of renal mass solitary kidney with high tumor complexity

You have accessJournal of UrologyCME1 Apr 2023PD43-04 MANAGEMENT OF RENAL MASS SOLITARY KIDNEY WITH HIGH TUMOR COMPLEXITY Worapat Attawettayanon, Yosuke Yasuda, JJ Zhang, Nityam Rathi, Carlos Munoz-Lopez, Kieran Lewis, Snehi Sha, Jianbo Li, Joao Accioly, Rebecca Campbell, Jihad Kaouk, Georges-Pascal Haber, Mohamad Eltemamy, Venkatesh Krishnamurthi, Robert Abouassaly, Christopher Weight, and Steven Campbell Worapat AttawettayanonWorapat Attawettayanon More articles by this author , Yosuke YasudaYosuke Yasuda More articles by this author , JJ ZhangJJ Zhang More articles by this author , Nityam RathiNityam Rathi More articles by this author , Carlos Munoz-LopezCarlos Munoz-Lopez More articles by this author , Kieran LewisKieran Lewis More articles by this author , Snehi ShaSnehi Sha More articles by this author , Jianbo LiJianbo Li More articles by this author , Joao AcciolyJoao Accioly More articles by this author , Rebecca CampbellRebecca Campbell More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber More articles by this author , Mohamad EltemamyMohamad Eltemamy More articles by this author , Venkatesh KrishnamurthiVenkatesh Krishnamurthi More articles by this author , Robert AbouassalyRobert Abouassaly More articles by this author , Christopher WeightChristopher Weight More articles by this author , and Steven CampbellSteven Campbell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003353.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial nephrectomy (PN) is preferred for renal mass in solitary kidney (RMSK), although tumors with high complexity (R.E.N.A.L=10-12) can be very challenging. Our objective was to evaluate the evolution of management for such patients, with focus on the pre-TKI (1999-2008) vs TKI (2009-2022) eras. METHODS: 499 RMSK were managed from 1999-2022 at our center; 133 had high R.E.N.A.L., including 80/53 patients in the early/late timeframes, respectively. After 2009, 23 patients received tyrosine kinase inhibitor (TKI) before surgery, and 30 had immediate surgery. Achievement of PN was the primary outcome; other outcomes included adverse events and surgical complications related to TKI, and recurrence-free and overall survival (RFS/OS). RESULTS: Overall, median R.E.N.A.L. and tumor diameter were 10/5.2 cm, respectively. Demographics, tumor diameter, and R.E.N.A.L were all similar in the early vs late cohorts. Non-confined pathology was found in 51%/58% of the early/late cohorts, respectively. In the late cohort, 23/53(43%) patients were selected for pre-surgical TKI. These 23 patients were the most challenging with increased median tumor diameter (7.1 vs. 4.4cm, p=0.02) and increased median R.E.N.A.L.(11 vs. 10, p=0.07). After TKI, median tumor diameter and R.E.N.A.L. were reduced to 5.6 cm and 9, and median tumor volume was reduced 59%. PN was accomplished in 21/23 (91%) of this cohort, and PN was also accomplished in 27/30 (90%) of the immediate surgery cases. In contrast, PN was only accomplished in 52/80(65%) patients in the pre-TKI era. 5-year dialysis-free survival was 91% vs 59% in the late vs early cohorts, respectively. Grade 3 adverse events related to TKI were observed in 11 patients (49%), and in this cohort, 5 urine leaks and one post-op. bleed were all managed successfully with conservative measures. Median follow-up was 41months; 5-year OS was 66%/71% in the early/late cohorts, respectively (p=0.5), while 5-year RFS were 73%/56%, respectively (p=0.07). Most recurrences were metastatic reflecting aggressive tumor biology, rather than failure of local management. CONCLUSIONS: RMSK with high tumor complexity is often locally advanced and challenging. Selective use of TKI may reduce the need for RN and augment dialysis-free survival. RFS mostly reflected aggressive tumor biology rather than failure of local management. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1119 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Worapat Attawettayanon More articles by this author Yosuke Yasuda More articles by this author JJ Zhang More articles by this author Nityam Rathi More articles by this author Carlos Munoz-Lopez More articles by this author Kieran Lewis More articles by this author Snehi Sha More articles by this author Jianbo Li More articles by this author Joao Accioly More articles by this author Rebecca Campbell More articles by this author Jihad Kaouk More articles by this author Georges-Pascal Haber More articles by this author Mohamad Eltemamy More articles by this author Venkatesh Krishnamurthi More articles by this author Robert Abouassaly More articles by this author Christopher Weight More articles by this author Steven Campbell More articles by this author Expand All Advertisement PDF downloadLoading ...