Page 7 - CUA2019 Abstracts - Oncology-Kidney

2019 CUA Abstracts

rosis, and arteriolar changes. Patients undergoing nephrectomy at our UP-9.8
centre were identified and included. Exclusion criteria included: loss Impact of time-to-surgery and surgical delay on oncological
to followup, obstructive nephropathy, preoperative end-stage renal dis- outcomes for renal cell carcinoma
ease, and bilateral nephrectomies. Patient demographics were described Benjamin Shiff , Rodney H. Breau , Premal Patel , Anil Kapoor , Frédéric
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using descriptive statistics. Multivariate logistic regression models were Pouliot , Alan I. So , Ricardo A. Rendon , Ronald B. Moore , Antonio
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created to assess the effect of NNK and other clinical factors on renal Finelli , Simon Tanguay , Luke T. Lavallée , Jean-Baptiste Lattouf , Jun
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function. Kawakami , Daniel Heng , Ranjeeta Mallick , Darrel E. Drachenberg 1
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Results: Sixty-three of 101 patients were deemed eligible for statistical 1 Urology, University of Manitoba, Winnipeg, MB, Canada; Urology,
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analysis at one year; 70% had a radical nephrectomy and the remainder University of Ottawa, Ottawa, ON, Canada; Urology, University of Miami,
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had a partial nephrectomy. The mean age and tumour size for patients Miami, FL, United States; Urology, McMaster University, Hamilton,
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were 62 years and 5.5 cm, respectively. History of smoking, hypertension, ON, Canada; Surgery, Université Laval, Québec City, QC, Canada;
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and diabetes was present in 38%, 43%, and 11%, respectively. Twenty 6 Urologic Sciences, University of British Columbia, Vancouver, BC,
percent of patients had CKD stage 3 or greater at baseline vs. 57% after Canada; Urology, Dalhousie University, Halifax, NS, Canada; Urology,
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one year. Mean estimated glomerular filtration rate (eGFR) prior to surgery University of Alberta, Edmonton, AB, Canada; Urology, University of
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was 68, while at one year it was reduced to 55. Glomerular sclerosis Toronto, Toronto, ON, Canada; Urology, McGill University, Montréal,
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severity on NNK assessment was predictive of decline in renal function QC, Canada; Surgery, Université de Montréal, Montréal, QC, Canada;
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and rise in serum creatinine. Having had a radical procedure and high 12 Medical Oncology, University of Calgary, Calgary, AB, Canada; Ottawa
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glomerular sclerosis score was associated with CKD stage progression Hospital Research Institute, Ottawa, ON, Canada
and thus renal function deterioration. Introduction: Surgical wait times (SWT) are a major concern in health-
Conclusions: This study demonstrated that NNK evaluation can be helpful care. In 2005, the Canadian Surgical Wait Time Consensus statement
in identifying patients who are at risk for the development or progres- suggested wait times of <90 days for T1a and <28 days for ≥T1b asymp-
sion of CKD. tomatic renal masses. Few reports have examined the effect of prolonged
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SWT for renal cancer surgery on oncological outcomes and those that
UP-9.7 exist were conducted on a single-institution level. We aimed to evaluate
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Management of small renal masses: Identifying barriers to the whether SWT is associated with treatment outcomes for renal masses on
use of renal tumour biopsy and interventions to optimize its a multi-institution level.
use in Ontario Methods: The Canadian Kidney information system (CKCis) is a national
Ranko Savic , Anna R. Gagliardi , Shabbir M. Alibhai , Lisa Martin , Maria multi-institution database of patients with kidney tumours. This database was
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Komisarenko , Patrick Richard , Antonio Finelli 1 used to identify a historical cohort of patients who underwent surgery for ≥
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1 Princess Margaret Cancer Centre, University Health Network and clinical stage T1b renal cell carcinoma (RCC) from 2011 onwards. Time from
University of Toronto, Toronto, ON, Canada; Toronto General Hospital final imaging prior to surgery to the date of surgery was used as a measure of
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Research Institute, University Health Network and University of Toronto, SWT. Oncological outcomes, such as recurrence-free survival (RFS), cancer-
Toronto, ON, Canada; Department of Medicine, University Health Network specific survival (CSS), and overall survival (OS) were stratified by clinical
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and University of Toronto, Toronto, ON, Canada; Faculty of Medicine and stage and SWT to assess for associations between SWT and outcomes.
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Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada Results: Of 1395 patients included in the analysis, 664 (47.6%) were
Introduction: Despite having high performance and low complication categorized as stage cT1b, 387 (27.7%) as stage cT2, and 344 (24.7%)
rates, renal tumuor biopsy (RTB) is underused in Canada. Some bar- as stage cT3/4. Mean followup duration was 28.80 months. Mean SWT
riers to the use of RTB have been previously identified using surveys. was 61.6 days, 39.3 days, and 31.5 days for stages cT1b, cT2, and cT3/4,
This study used open-ended interviews in Ontario to examine barriers respectively. Among cT1b, cT2, and cT3/4 patients, SWT exceeded 12
and facilitators to the use of RTB, and identify potential interventions to weeks in 27.4%, 11.6%, and 8.1% of patients, respectively. There was no
overcome the barriers. association between SWT and RFS, margin status, or lymph node status
Methods: Recruitment packages were mailed to all currently active urolo- for tumours of all clinical stages.
gists in Ontario (n=307) using contact information from the publicly avail- Conclusions: Mean SWTs for renal cancer surgery appear to be within
able Canadian Physicians and Surgeons of Ontario database. Followup recommendations, although a significant proportion of cT1b patients are
recruitment packages were sent two weeks later. Semi-structured, open- experiencing prolonged wait times. Patients who had longer SWTs in this
ended telephone interviews were conducted with urologists who agreed study did not experience negative oncological outcomes, such as positive
to participate. Interviews were audio-recorded and transcribed verbatim. margins, positive lymph nodes, or worse RFS among all clinical stages.
Themes were identified using a basic descriptive qualitative approach. References
Results: Twenty-four urologists were interviewed (response rate 8%). 1. Aprikian A, Bagnell S, Bell D, et al. Consensus document:
Participants were from academic (n=12) and community (n=12) hospital Recommendations for optimal surgical wait times for patients with
settings. The main themes for RTB barriers were clinician barriers, RTB urological malignancies. Can J Urol 2006;13Suppl 3:62-4.
guideline and literature factors, patient barriers, resources, and organiza- 2. Stec AA, Coons BJ, Chang SS, et al. Waiting time from initial urologi-
tional/system factors. “Lack of radiologist experience in performing RTB” cal consultation to nephrectomy for renal cell carcinoma — does it
was a novel subtheme identified through this work. When considering affect survival? J Urol 2008;179:2152-7. https://doi.org/10.1016/j.
RTB facilitators, multidisciplinary teamwork facilitators, and institutional juro.2008.01.111
factors were the main themes. “Good interaction between different clini- 3. Martínez CH, Martin P, Chalasani V, et al. How long can patients
cians” was identified as a subtheme. The key recommended interventions with renal cell carcinoma wait for surgery without compromising
by urologists were resources for RTB, education on RTB, and guidelines pathological outcomes? Can Urol Assoc J 2011;5:148-51. https://
for RTB. A novel recommended intervention was “teach urologists to doi.org/10.5489/cuaj.10035
perform their own RTBs.” 4. Hyun Kim K, You D, Gab Jeong I, et al. The impact of delaying
Conclusions: This research elucidated barriers not previously identified in radical nephrectomy for stage II or higher renal cell carcinoma. J
the literature. Barriers from the interviews, along with potential interven- Cancer Res Clin Oncol 2012;138:1561-7. https://doi.org/10.1007/
tions to overcome them, are currently being ranked by a panel of experts s00432-012-1230-2
to determine which intervention is the most appropriate to optimize the
use of RTB in Ontario.
S146 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)