Page 2 - CUA2018 Abstracts - Robotics

Poster session 8: robotics/Other Urology topics

or five–year (0.83; p=0.18) followup. Pump time did not significantly 2. Pak JS, Lee JJ, Bilal K, et al. Utilization trends and outcomes up to
predict rejection or graft survival. Five individuals experienced signifi- 3 months of open, laparoscopic, and robotic partial nephrectomy. J
cant perioperative hypotension and a there was a total of six episodes of Robotic Surg 2017;11:223–9. https://doi.org/10.1007/s11701–016–
rejection during the study period. There were no significant differences 0650–4
between the two groups in complications or mortality.
Conclusions: The addition of verapamil in pumped kidneys resulted in MP–8.5
significant improvements in one–year eGFR. This is the first randomized
control trial examining this issue to date. Urological conditions in nonagenarians
Tarek Lawen , Ashley Cox , Karthik Tennenkore 2
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1 Urology, Dalhousie University, Halifax, NS, Canada; Nephrology,
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MP–8.4 Dalhousie University, Halifax, NS, Canada
Is access to robotic partial nephrectomy associated with use of Introduction: The Canadian population is rapidly aging, with centenarians
partial nephrectomy or minimally invasive partial nephrectomy? comprising the fasting growing age group nationally. Sparse urological
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Patrick Anderson , Nicholas Power , Michael Jewett , Antonio Finelli , research exists on nonagenarians. The purpose of our study was to assess
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Jean–Baptiste Lattouf , Ricardo Rendon , Simon Tanguay , Anil Kapoor , the most common urologicalal referrals and diagnoses in nonagenarian
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Jun Kawakami , Adrian Fairey , Alan So , Darrel Drachenberg , Laurence patients. We also sought to determine which investigations and treatment
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Klotz , Frédéric Pouliot , Robert Sabbagh , Luke Lavallee , Rodney Breau 1 modalities were used by urologists and how frequently management was
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1 Ottawa Hospital Research Institute and the University of Ottawa, Ottawa, altered due to patient age.
ON, Canada; London Health Sciences Centre, Western University, Methods: A retrospective chart review of all referrals in patients aged
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London, ON, Canada; Princess Margaret Cancer Centre, University 90–99 at time of referral was carried out at a single academic institute.
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Health Network and University of Toronto, Toronto, ON, Canada; This included referrals to 11 urologists from 2007–2017. Electronic health
4 Université de Montréal, Montreal, QC, Canada; Dalhousie University records were reviewed.
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and Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada; Results: A total of 106 nonagenarian patients were identified (66% male;
6 McGill University and McGill University Health Centre, Montreal, 34% female). Mean age at referral was 91.9 years. The most common
QC, Canada; McMaster University, Hamilton, ON, Canada; Southern reasons for referral for males were hematuria, lower urinary tract symp-
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Alberta Institute of Urology, University of Calgary, Calgary, AB, Canada; toms (LUTS), and urinary retention (27%, 20%, and 18%, respectively);
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9 University of Alberta, Edmonton, AB, Canada; University of British for women, they were hematuria, urinary tract infections (UTI), and LUTS
Columbia, Vancouver, BC, Canada; University of Manitoba, Winnipeg, (33%, 22%, and 19%, respectively). After seeing the urologist, the most
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MB, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; common male diagnoses were benign prostatic hyperplasia (BPH), stones,
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13 Hôtel–Dieu de Québec, Quebec City, QC, Canada; Centre Hospitalier and urinary retention (20%, 16%, 13%, respectively). The most common
Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, female diagnoses were bladder tumour, UTI, and cystitis (22%, 11%,
Canada 9%, respectively). Flexible cystoscopy was used in 51% of males and
Study Groups: Canadian Kidney Cancer information system (CKCis). 64% of females. Twenty–eight percent of females underwent computed
Introduction: Partial nephrectomy is the preferred surgical treatment tomography. Nineteen percent of men were managed with indwelling
for clinical stage T1 renal masses For some surgeons, robotic surgery catheters and 20% of females were managed with antibiotics. In 18%
.1
may allow for more complex renal tumours to be resected using a lap- of cases overall, the urologist deviated from gold–standard management
aroscopic approach. The objective of this study was to determine if due to the patient’s advanced age. Only 10/15 patients diagnosed with
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access to robotic partial nephrectomy is associated with the proportion bladder tumours underwent resection.
of patients with cT1 treated with a partial nephrectomy or minimally Conclusions: Nonagenarians referred to urology often present with com-
invasive partial nephrectomy. mon urinary symptoms. BPH, bladder tumours, and UTIs are common
Methods: The Canadian Kidney Cancer information system (CKCis) is a diagnoses in this population. Despite common diagnoses, at times, man-
multicentre, prospectively collected database of renal tumour patients agement plans vary due to very advanced age. Further research is ongoing
initiated in 2011. A cohort of cT1 patients was reviewed to determine the to assess the management of nonagenarians.
proportions of patients managed with open or MIS (pure laparoscopic or References:
robotic–assisted laparoscopic) partial nephrectomy. Surgical management 1. Government of Canada Statistics. Data products, 2016 census
at centres with access to robotic partial nephrectomy were compared to (Dec. 12, 2017). Available at www12.statcan.gc.ca/census–recen-
centres that did not have access to robotic partial nephrectomy. sement/2016/dp–pd/index–eng.cfm. Accessed April 5, 2018.
Results: During the study period, 3546 cT1 patients had partial (2417, 2. Government of Canada Statistics. Centenarians in Canada. Dec 21,
68%) or radical (1130, 32%) nephrectomy. Nine of 16 centres had at least 2015. Available at www12.statcan.gc.ca/census–recensement/2011/
one year when robotic partial nephrectomy was performed. Centres with as–sa/98–311–x/98–311–x2011003_1–eng.cfm. Accessed April 5,
access to robotic partial nephrectomy more commonly performed partial 2018.
nephrectomy compared to non–robotic centres (73% vs. 57%; p<0.001) 3. Hosking MP, Warner MA, Lobdell CM, et al. Outcomes of surgery
and more commonly performed MIS partial nephrectomy (41% vs. 29%; in patients 90 years of age and older. JAMA 1989;261:1909–15.
p<0.001). Overall, 1262 (52%) patients had MIS partial nephrectomy and https://doi.org/10.1001/jama.1989.03420130077027
1155 (48%) had open partial nephrectomy. Among partial nephrectomy 4. Pridgeon S, Nagarajan E, Ellis G, et al. The use of urological hospital
patients, sites with access to robotic partial nephrectomy used an MIS services by nonagenarians. Ann R Coll Surg Engl 2016;98:181–6.
approach in 57% of patients compared to non–robotic sites, where an https://doi.org/10.1308/rcsann.2016.0002
MIS approach was used for 42% of patients (p<0.001).
Conclusions: Partial nephrectomy is the most common surgical manage-
ment of patients with cT1 renal tumours. Centres with access to robotic
partial nephrectomy more commonly perform partial nephrectomy and
MIS partial nephrectomy compared to sites without access to robotic
surgery. Further analyses, adjusting for years of robotic access, case mix,
and case volume will aim to determine if the proportions of MIS partial
nephrectomy increase after a robotic renal surgery program is initiated.
References:
1. Campbell SC, Novick AC, Belldegrun A, et al. Guideline for manage-
ment of the clinical T1 renal mass. J Urol 2009;182:1271. https://
doi.org/10.1016/j.juro.2009.07.004
CUAJ • June 2018 • Volume 12(6Suppl2) S109