Page 7 - CUA 2020_Functional Urology

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
4
3
2
1
Opioid use after nephrectomy for kidney cancer in Ontario: A Arnon Lavi , Rodney H. Breau , Ranjeeta Mallick , Anil Kapoor , Antonio
7
6
2
5
8
population-based study Finelli , Alan I. So , Frédéric Pouliot , Simon Tanguay , Luke T. Lavallée ,
10
9
11
Douglas C. Cheung , Lisa Martin , Maria Komisarenko , Naheed Jivraj , Ricardo A. Rendon , Adrian Fairey , Darrel E. Drachenberg , Jean-Baptiste
1
1
1
2
5
12
Christina Diong , Olli Saarela , Madhur Nayan , Hance Clarke , Duminda Lattouf , Ranjena Maloni , Nicholas E. Power 1
3
4
1
2
Wijeysundera , Tara Gomes , Girish S. Kulkarni , Shabbir M. Alibhai , 1 Urology Division, Department of Surgery, Schulich School of Medicine
2
5
1
6
2
Antonio Finelli 1 and Dentistry, Western University, London, ON, Canada; Department
3
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,
2
4
Toronto, ON, Canada; ICES, Toronto, ON, Canada; Department of Canada; McMaster Institute of Urology, St. Joseph’s Healthcare, Hamilton,
3
4
5
Biostatistics, University of Toronto, Toronto, ON, Canada; Unity Health, ON, Canada; Division of Urologic Oncology, Princess Margaret
5
6
Toronto, ON, Canada; Division of Internal Medicine and Geriatrics, Hospital, University of Toronto, Toronto, ON, Canada; Department
6
University Health Network, Toronto, ON, Canada of Urologic Sciences, University of British Columbia, Vancouver, BC,
7
Introduction: Adequate control of postoperative pain is important to Canada; Department of Surgery, Division of Urology, Université Laval,
8
allow for optimal recovery; however, 5–10% of patients develop per- Quebec City, QC, Canada; Department of Urology, McGill University
9
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,
10
ity. In this population-based study, we compare the rates of early and Canada; Division of Urology, University of Alberta, Edmonton, AB,
11
prolonged postoperative opioid use in patients undergoing open vs. MIS Canada; Division of Urology, University of Manitoba, Winnipeg, MB,
12
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
1
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.
2-5
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)