MP37-10 COMPARISON OF CANCER-SPECIFIC OUTCOMES FOLLOWING OPEN VERSUS MINIMALLY-INVASIVE SURGERY FOR T1 KIDNEY CANCER

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy II (MP37)1 Apr 2019MP37-10 COMPARISON OF CANCER-SPECIFIC OUTCOMES FOLLOWING OPEN VERSUS MINIMALLY-INVASIVE SURGERY FOR T1 KIDNEY CANCER Gregory Auffenberg*, Michael Curry, Renee Genarrelli, Elena Elkin, and Paul Russo Gregory Auffenberg*Gregory Auffenberg* More articles by this author , Michael CurryMichael Curry More articles by this author , Renee GenarrelliRenee Genarrelli More articles by this author , Elena ElkinElena Elkin More articles by this author , and Paul RussoPaul Russo More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556040.71806.e9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: As is common with many technologic advances, adoption of minimally invasive kidney cancer surgery (MIS) has somewhat outpaced rigorous research comparing MIS to traditional techniques. After observing multiple, atypical recurrences among those with low stage disease; we sought to compare cancer-specific outcomes among patients with T1 kidney cancer undergoing open versus MIS excision. METHODS: Using SEER – Medicare data, we identified patients over 65 with unilateral, clinical stage T1N0M0, non-urothelial kidney cancer who underwent surgical excision (i.e., radical or partial nephrectomy) as initial treatment between 2004 and 2013. After stratifying the cohort based on whether surgery was open or MIS, we evaluated for an association between approach and four outcomes: overall and cancer-specific survival, rates of second kidney cancer surgery, and rates of post-operative systemic cancer therapy. Regression was used to account for differences across study groups–included covariates: histologic sub-type, grade, radical versus partial nephrectomy, receipt of second treatment, year, Charlson co-morbidity, and age at diagnosis. RESULTS: 5,150 patients met criteria for cohort inclusion. 3,062 (59.5%) underwent MIS. Cox-regression demonstrated no differences in overall or cancer-specific survival associated with surgical approach (HR=1.02, 95% CI 0.91-1.14 and HR=1.00 95% CI 0.87-1.15, respectively; open surgery = reference group). Kaplan-Meier analyses showed no differences in rate of second surgery, however recipients of MIS were more likely to receive systemic cancer therapy (Figure). Importantly, the association between MIS and increased receipt of systemic therapy persisted after adjusting for covariates (HR=1.32; 95% CI 1.09-1.59; p=0.005). CONCLUSIONS: Among patients with T1 kidney cancer, surgical approach (open vs. MIS) was not associated with differences in overall survival, cancer-specific survival, or receipt of second cancer surgery, however, those receiving MIS were more likely to receive systemic cancer therapy post-operatively. As systemic therapy is typically reserved for patients with disease recurrence, this may indicate an important difference in cancer-specific outcomes attributable to surgical approach. Source of Funding: none Chicago, IL; New York, NY© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e527-e527 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gregory Auffenberg* More articles by this author Michael Curry More articles by this author Renee Genarrelli More articles by this author Elena Elkin More articles by this author Paul Russo More articles by this author Expand All Advertisement PDF downloadLoading ...