Page 8 - CUA2018 Abstracts - Oncology-Bladder

Poster session 10: Other Oncology II

patients undergoing primary resection of T1 BC, in which either a perfect MP–10.5
MEGS or the 2004 WHO grading system was used for primary grading Real–time Intraoperative Surgical Competency (RISC)
assessment. Transition probabilities and utilities were derived from litera- assessments: Development and validation of a procedure–
ture search and expert consensus. specific evaluation tool for transurethral resection of bladder
Results: Use of a MEGS at the primary resection of T1 BC, compared to tumours
the use of the 2004 WHO grading system, was associated with 0.3 more Mitchell Goldenberg , Michael Elfassy , Michael Jewett , Armando
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quality–adjusted life years (discounted 1.5%: 13.1 vs. 12.8, undiscounted: Lorenzo , Matthew Roberts , Trustin Domes , Mohammed Mahdi , Ethan
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15.5 vs. 15.2). Our model showed extremal validity when compared to a Grober 1
large, population–based study. The benefit is more pronounced in younger 1 Division of Urology, University of Toronto, Toronto, ON, Canada;
patients and in patients who suffer more from the decrease in quality of 2 Division of Urology, University of Ottawa, Ottawa, ON, Canada;
life associated with the post–cystectomy state. Assuming a willingness 3 Division of Urology, University of Saskatchewan, Saskatoon, SK, Canada
to pay of $50 000 per incremental quality–adjusted life year, a MEGS Introduction: Competency–based training requires valid and reliable
test should not cost more than $15 000 per patient to be cost–effective. assessment tools for educators to evaluate surgical skill. Transurethral
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Conclusions: The use of a perfect MEGS compared to the use of the 2004 resection of bladder tumours (TURBT) is a common surgery performed by
WHO grading system is beneficial in patients undergoing primary resec- trainees at all levels, as well as experienced faculty urologists. We report
tion of T1 BC. The effectiveness of MEGS has to be evaluated in light of on the initial validation of a TURBT–specific assessment tool to evaluate
costs as soon as these systems reach clinical maturity. intraoperative surgical performance.
Methods: Fifty unedited intraoperative TURBT videos were indepen-
MP–10.4 dently reviewed by three expert surgeons to identify fundamental tech-
Ureteroenteric strictures: Long–term outcomes at a single nical skill domains thought to influence surgical outcomes following
institution TURBT. Consensus was reached through direct discussion. The Real–time
Humberto Vigil , Sender Herschorn 1 Intraoperative Surgical Competency (RISC) assessment tool is composed
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1 Division of Urology, Sunnybrook Health Sciences Centre, University of of 20 Likert scale skill domains (GRS) and a final product quality score
Toronto, Toronto, ON, Canada (FPS) (Fig. 1; available at https://cua.guide/). Assessment of trainee and
Introduction: Ureteroenteric stricture (UES) following urinary diversion faculty performance during a series of sequential TURBT cases at two
(UD) is a dreaded complication. Open reimplantation has remained the institutions were captured to provide validity evidence for RISC. Each
gold standard treatment. We set out to evaluate long–term outcomes in a case was blindly evaluated by at least two expert surgeons. Inter–rater
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heterogeneous group of patients who underwent reimplantation for UES. reliability and correlations of RISC scores with prior TURBT experience
Methods: Patients were retrospectively captured from a single surgeon’s and training level were performed.
experience at a major referral centre in Canada between April 2000 and Results: A total of 176 TURBT cases were completed by a junior resi-
August 2017. Patients had either a continent or incontinent UD for a dent (124, 66.3%), senior resident (29, 15.5%), or faculty (23, 12.3%) as
variety of diagnoses. Patients diagnosed with a benign UES underwent the primary surgeon. Among trainee participants, RISC scores improved
open reimplantation with the creation of a refluxing anastomosis. We chronologically during the study period. Inter–rater reliability among the
reviewed clinicopathological and outcome variables using statistical expert evaluators was good for RISC GRS scores (Cronbachs alpha=0.65)
measures of variability. and moderate for RISC FPS scores (Cronbachs alpha=0.55). GRS scores
Results: Twenty–four patients and 34 renal units underwent open reim- correlated significantly with previous TURBT experience (0.2; p=0.038)
plantation for benign UES. Median followup was 48 months (interquartile and training level (0.2; p=0.034), and FPS scores correlated with partici-
range [IQR] 8–92). Seventy–five percent of patients underwent UD for pant training level (0.21; p=0.032).
malignancy. Benign diagnoses included exstrophy, spina bifida, neuro- Conclusions: Through the application of a contemporary framework, mul-
genic bladder, and infection. Forty–four percent of malignant patients tiple sources of construct validity were established for the RISC assessment
received radiation. Sixty–seven percent of UD were incontinent and ileal of TURBT. Similar methodology can used to apply RISC assessments to
conduit was most common overall. Median time from UD to UES was 20 other surgeries relevant to urology training.
months (IQR 11.3–129). Forty–two percent of patients had a history of Reference:
failed endoscopic surgery in the form of balloon dilation in nine patients 1. Frank JR, Snell LS, Cate OT, et al. Competency–based medical edu-
and endoureterotomy in one. Median time to surgery was 12 months (IQR cation: Theory to practice. Med Teach 2010;32:638–45. https://doi.
5.5–21.5). Five patients had minor iatrogenic enterotomies. There were org/10.3109/0142159X.2010.501190
no major complications. The median postoperative stent dwell time was
four weeks (IQR 2–4). Median hospital stay was 8.5 days (IQR 7–10). A MP–10.6
total of two renal units developed recurrent UES at a median followup Renal cell carcinoma in the Canadian Indigenous population
of 91.5 months. Prior to recurrence, these patients suffered from recur- Emily Wong , Anil Kapoor , Ranjeeta Mallick , Lori Wood , Simon Tanguay ,
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rent infections. Both renal units were salvaged with repeat reimplantation. Frédéric Pouliot , Naveen Basappa , Alan So , Denis Soulières , Darrel
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Conclusions: Open reimplantation is associated with good long–term out- Drachenberg , Luke Lavallee , Rodney Breau 10
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comes and low morbidity in a diverse group of UD patients. Recurrences 1 Urology, McMaster University, Hamilton, ON, Canada; Ottawa
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occurred several years later and were likely related to chronic infection Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada;
rather than surgical factors. 3 Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax,
Reference: NS, Canada; Urology, McGill University Health Centre, Montreal,
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1. Packiam VT, Agrawal VA, Cohen AJ, et al. Lessons from 151 ure- QC, Canada; Urology, Université Laval, Quebec City, QC, Canada;
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teral reimplantations for postcystectomy ureteroenteric strictures: A 6 Medical Oncology, Cross Cancer Institute, Edmonton, AB, Canada;
single–center experience over a decade. Urol Oncol 2017;35:112. 7 Urology, University of British Columbia, Vancouver, BC, Canada; Centre
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e19–112. https://doi.org/10.1016/j.urolonc.2016.10.005 Hospitalier de l’Université de Montréal, Université de Montréal, Montreal,
QC, Canada; Urology, University of Manitoba, Winnipeg, MB, Canada;
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10 Urology, The Ottawa Hospital, Ottawa, ON, Canada
Introduction: Diagnosis and treatment of renal cell carcinoma (RCC)
in Indigenous Canadians (IC) may be different than non–Indigenous
Canadians (NIC). The present study aims to evaluate RCC presentation
and treatment in the IC population compared to the NIC population.
Methods: Using the Canadian Kidney Cancer information system, pro-
spective patients from 16 institutions between 2011 and 2017 were
CUAJ • June 2018 • Volume 12(6Suppl2) S119