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2020 CUA Abstracts





        impact on their HRQOL. The results highlight the importance of dedi-  UP-3.9
        cated HRQOL survivorship assessment and tailored intervention in this   Adrenalectomy during radical nephrectomy: Oncological
        population.                                          outcomes from the Canadian Kidney Cancer Information System
                                                             (CKCis) – a modern-era, nationwide, multicenter, Canadian
        UP-3.8                                               cohort
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        Opioid use after nephrectomy for kidney cancer in Ontario: A   Arnon Lavi , Rodney H. Breau , Ranjeeta Mallick , Anil Kapoor , Antonio
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        population-based study                               Finelli , Alan I. So , Frédéric Pouliot , Simon Tanguay , Luke T. Lavallée ,
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        Douglas C. Cheung , Lisa Martin , Maria Komisarenko , Naheed Jivraj ,   Ricardo A. Rendon , Adrian Fairey , Darrel E. Drachenberg , Jean-Baptiste
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        Christina Diong , Olli Saarela , Madhur Nayan , Hance Clarke , Duminda   Lattouf , Ranjena Maloni , Nicholas E. Power 1
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        Wijeysundera , Tara Gomes , Girish S. Kulkarni , Shabbir M. Alibhai ,   1 Urology Division, Department of Surgery, Schulich School of Medicine
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        Antonio Finelli 1                                    and Dentistry, Western University, London, ON, Canada;  Department
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        1 Department of Surgery, Division of Urology, University Health Network,   of Urology, The Ottawa Hospital, Ottawa, ON, Canada;  School of
        Toronto, ON, Canada;  Department of Anesthesia, University of Toronto,   Epidemiology and Public Health, University of Ottawa, Ottawa, ON,
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        Toronto, ON, Canada;  ICES, Toronto, ON, Canada;  Department of   Canada;  McMaster Institute of Urology, St. Joseph’s Healthcare, Hamilton,
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        Biostatistics, University of Toronto, Toronto, ON, Canada;  Unity Health,   ON, Canada;  Division of Urologic Oncology, Princess Margaret
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        Toronto, ON, Canada;  Division of Internal Medicine and Geriatrics,   Hospital, University of Toronto, Toronto, ON, Canada;  Department
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        University Health Network, Toronto, ON, Canada       of Urologic Sciences, University of British Columbia, Vancouver, BC,
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        Introduction: Adequate control of postoperative pain is important to   Canada;  Department of Surgery, Division of Urology, Université Laval,
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        allow for optimal recovery; however, 5–10% of patients develop per-  Quebec City, QC, Canada;  Department of Urology, McGill University
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        sistent opioid use. This effect may be more pronounced following open   Health Centre, Montreal, QC, Canada;  Department of Urology,
        vs. minimally invasive (MIS) nephrectomy due to the incisional morbid-  QEII Health Sciences Centre, Dalhousie University, Halifax, NS,
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        ity. In this population-based study, we compare the rates of early and   Canada;  Division of Urology, University of Alberta, Edmonton, AB,
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        prolonged postoperative opioid use in patients undergoing open vs. MIS   Canada;  Division of Urology, University of Manitoba, Winnipeg, MB,
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        nephrectomy.                                         Canada;  Division of Urology, University of Montreal Hospital Centre
        Methods: Opioid-naive patients who underwent nephrectomy for kidney   (CHUM), Montreal, QC, Canada
        cancer in Ontario (1994–2018) were identified from the ICES databases.   Support: Kidney Cancer Research Network; The Canadian Kidney Cancer
        Published definitions of early (opioid prescription [Rx] 1–90 days after   information system (CKCis)
        surgery) and prolonged (1: recurrent Rx use in both 1–90 and 91–180   Introduction: Ipsilateral adrenal involvement of renal cell carcinoma
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        days after surgery; and 2: Rx duration for ≥60 days between 90–365 days   occurs in up to 4% of radical nephrectomies.  However, incidental ipsilat-
        after surgery) opioid use were measured. Two cohorts were generated:   eral adrenalectomy is commonly performed during radical nephrectomy.
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        using the Ontario Drug Benefits database (ODB; primarily patients over   A benefit of incidental adrenalectomy has not been demonstrated.  The
        age 65; n=5263) and Narcotics Monitoring System (NMS; available after   objective of this study was to identify the association between adrenal-
        2012 in all ages; n=4472). Predictors of opioid use were assessed by   ectomy and oncological outcomes in a contemporary cohort.
        multivariable logistic regression.                   Methods: We identified a cohort of radical nephrectomy patients in the
        Results: Early opioid Rx was higher following open vs. MIS nephrectomy   Canadian Kidney Cancer information system (CKCis) who had surgery
        in the NMS cohort only (74 vs. 69%, p<0.01). Overall, prolonged opioid   between 2011 and 2019. Patient, tumor, and surgical characteristics were
        use was low (1–5%). In the ODB cohort, prolonged Rx was higher for   obtained. The primary outcomes were renal cell carcinoma (RCC) recur-
        open vs. MIS in one of two definitions (5.3 vs. 3.9%, p=0.02; 1.9 vs. 1.4%,   rence and death.
        p=0.19). In the NMS cohort, prolonged Rx was not different between   Results: During the study period, 2726 patients were identified; 827
        surgeries. After adjustment for patient, surgical, physician, and hospital   (30.3%) had incidental adrenalectomy. Age, race, smoking status, body
        characteristics, the odds of early opioid Rx were significantly higher for   mass index (BMI), family history of RCC and preoperative creatinine
        open vs. MIS in both cohorts (odds ratio [OR] 1.19 [1.03–1.37], p=0.02;   were similar between the groups. The adrenalectomy group had more
        OR 1.35 [1.15–1.56], p<0.01). Surgery type was not significantly associ-  advanced disease features: lower Eastern Cooperative Oncology Group
        ated with prolonged opioid Rx in either cohort or definition.  status (p=0.004), longer procedure length (p<0.0001), higher blood loss
        Conclusions: Early opioid Rx was higher for patients who underwent   (p<0.0001), higher % of tumor thrombus (p<0.0001), pT (p<0.0001),
        open vs. MIS nephrectomy. Prolonged opioid Rx ranged from 1–5% of   pN(p=0.006), M status (p<0.0001), Fuhrman grade (p<0.0001), and % of
        patients, depending on the definition, but did not differ significantly by   clear-cell histology (p=0.027). The rate of adrenal involvement was 3.9%.
        type of surgery.                                     Median followup was 22 months (range 7.8–44.7). Adjusting for known
                                                             confounders, adrenalectomy was associated with lower overall survival
                                                             but not recurrence-free survival (Tables 1, 2).
         UP-3.9. Table 1. Univariable and multivariable association for overall survival
                                         Overall survival (univariate)          Overall survival (multivariate)
         Parameter               Hazard      95% hazard ratio     p      Hazard      95% hazard ratio     p
                                  ratio        confidence                 ratio        confidence
                                                 Limits                                  Limits
         Age                      1.04      1.02       1.05    <0.0001
         Charlson score           1.27      1.18       1.37    <0.0001     1.3       1.18      1.42    <0.0001
         Tumor grade              2.78      2.04       3.79     <.0001     2.17      1.63      2.88    <0.0001
         Tumor margin             3.81      2.51       5.8     <0.0001     2.64      1.79      3.84    <0.0001
         Tumor size               1.07      1.05       1.08    <0.0001     1.06      1.04      1.07    <0.0001
         Adrenalectomy            1.89       1.5       2.35    <0.0001     1.28      1.03      1.6      0.028
        S70                                     CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)
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