Page 9 - CUA 2020_Functional Urology

2020 CUA Abstracts

therapeutic intervention. Variables such as age, American Society of UP-3.13
Anesthesiologists (ASA) class, Eastern Cooperative Oncology Group Anatomical characterization of the inguinal lymph nodes using
(ECOG) score, lesion size, year of diagnosis, and patient-volume at the microcomputed tomography to inform radical inguinal lymph
referring center were analyzed as possible factors associated with RTB node dissections for metastatic penile cancer
use. Univariable and multivariable logistic regression models were used. Kaitlin Marshall , Nicholas E. Power , Shiva Nair , Katherine E Willmore ,
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Results: A total of 807 patients (23.9%) underwent RTB. There was an Tyler S Beveridge 1
overall increase in RTB use with time (p=0.002), with patients diag- 1 Department of Anatomy & Cell Biology, Schulich School of Medicine
nosed in later years (2015–2019) undergoing RTB more often than in & Dentistry, Western University, London, ON, Canada; Department of
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earlier years (2011–2014) (27.7% vs. 20.7%, respectively; p<0.001). Surgery, Divisions of Urology and Surgical Oncology, Schulich School of
On multivariable analysis, increasing year of diagnosis was significantly Medicine & Dentistry, Western University, London, ON, Canada
associated with more RTB use (odds ratio 1.12; 95% confidence inter- Introduction: In men with penile cancer, a radical inguinal lymph
val 1.02–1.22; p=0.017). Patients managed in centers from the highest node dissection (rILND) is integral to improve disease-specific survival.
patient-volume quartile had RTB more frequently than patients from Unfortunately, lymphocele and lymphedema are severe postoperative
low-volume centers (p<0.001). complications that can follow this procedure. A modified inguinal lymph
Conclusions: Our results reveal an increasing popularity and overall use of node dissection was developed to reduce complications; however, it is not
RTB among Canadian urologists. Our findings also suggest a greater use suited for patients with advanced-stage disease and further modification
of RTB in larger-volume centers. This study highlights the large influence is limited by our understanding of the lymphatic anatomy in this region.
of physician perceptions in the decision to use RTB and stresses the Therefore, this study aims to elucidate the lymphatic anatomy within the
importance of providing urologists with evidence-based information on current surgical borders of a rILND using human cadavers.
the role of RTB in the management of SRMs. Methods: To visualize the position of the lymph nodes, tissue packets
excised from the inguinal region were imaged using microcomputed
UP-3.12 tomography (154 μm Locus Ultra CT scanner; 80 kVp, 55 mA, 0.36
A 21-year, population-based comprehensive review of surgically degrees per view). To characterize the distribution of lymph nodes within
treated kidney cancer in Manitoba each tissue packet, lymph nodes were segmented by grayscale values
Ryan Sun , Benjamin Shiff , Oksana Harasemiw , Navdeep Tangri , Lourens in 3D using a modified seed-growing algorithm (Region Growing v1.5;
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Jacobs , Jeffery W. Saranchuk , Rahul K. Bansal , Darrel E. Drachenberg , Kellner, 2011) in MATLAB. To compare anatomy between specimens,
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Jasmir (Jay) G. Nayak 1 each lymph node packet was registered in a common coordinate system
1 Urology, University of Manitoba, Winnipeg, MB, Canada by aligning four landmarks (anterior superior iliac spine, pubic tubercle,
Introduction: Partial nephrectomy (PN) has become an increasingly used saphenofemoral junction and the apex of the femoral triangle) using a
option for localized kidney cancer compared to radical nephrectomy generalized Procrustes analysis.
(RN), due to its advantage of renal preservation and seemingly equivalent Results: Preliminary findings from five samples (n=3 cadavers; two male,
oncological efficacy in several studies. However, there are conflicting one female) show a median of six lymph nodes (range 3–7) and their
reports of survival benefits, and the technical challenges of PN also lead distribution is illustrated in Fig. 1.
to potential for increased perioperative complications. In this study, we Conclusions: This study provides the first standardized comparison of
aim to compare the survival and perioperative outcomes between patients lymph node anatomy in the inguinal region, and uses a novel imaging
who underwent PN and RN for renal cell carcinoma (RCC) using a large, methodology validated by our lab to study the anatomy of lymphatic tissue
population-based cohort database. in 3D and in situ. In doing so, the anatomy elucidated in this study will
Methods: We performed a retrospective cohort study by analyzing patient- help inform refinement to the borders of the radical surgical template,
level data of all patients within the province of Manitoba who underwent to limit unnecessary resection in an attempt to reduce the incidence of
either RN or PN for RCC from 1995–2015, by linking multiple provincial post-surgical lymphedema and/or lymphocele.
administrative health registries.
Results: Of 2604 patients identified who underwent surgery for RCC, 565
(21.7%) underwent PN and 2039 (78.3%) underwent RN. PN patients
were significantly younger (mean 59.6 vs. 63.0 years, p <0.001), had a
lower mean Charlson comorbidity index (CCI) (6.2 vs. 7.8, p<0.001),
and a smaller mean tumor size (3.3 vs. 6.5 cm, p<0.01). Most (86.6%)
of PN tumors were pT1, compared to 47.5% of RN tumors. PN patients
were less likely to require initiation of dialysis postoperatively compared
to RN patients (4.07% vs. 8.63%, p=0.0003). After a median followup
of 5.0 (2.1–9.7) years, the overall survival rate was significantly higher
in PN (85.54%) than RN (54.10%). The five-year estimated survival rates
were 69.46% for RN compared with 87.60% for PN (p<0.0001). There
were no significant differences in 30-day and 90-day readmission rates
between the two groups.
Conclusions: Within the provincial population cohort, PN was associated
with improved survival and yielded similar 30-day or 90-day readmission
rates compared to RN. These results will require further evaluation with
comparativeness effectiveness methodology.
UP-3.13. Fig. 1. The standardized lymph node data after having generalized
Procrustes analysis applied. The dotted lines represent the rILND surgical
borders.

S72 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)