Alberto, Lapini

Alessandro, Antonelli

Alessandro, Volpe

Alexander, Kutikov

Brian, Lane

Bulent, Akdogan

Campi, Riccardo

Carini, Marco

Francesco, Sanguedolce

Georgios, Hatzichristodoulou

Hans, Langenhuijsen

Marco, Roscigno

Mari, Andrea

Martin, Marszalek

Minervini, Andrea

Nihat, Karakoyunlu

Oscar Rodriguez faba,

Ottavio De Cobelli,

Sabine Brookman may,

Tobias, Klatte

Uzzo, Robert G.

English

Campi, R.

Mari, A.

Florence Research

V10 RESECTION TECHNIQUES FOR NEPHRON SPARING SURGERY VARY: INSIGHTS FROM A PROSPECTIVELY COLLECTED MULTI-INSTITUTIONAL COHORT HARNESSING THE SURFACE–INTERMEDIATE–BASE (S.I.B.) MARGIN SCORE (SIB INTERNATIONAL CONSORTIUM)

Introduction: Detailed reporting of resection strategies (RS)and resection techniques (RT) for tumor excision during partialnephrectomy (PN) is lacking in the current literature. The aimof the study was to evaluate (i) possible correlations betweenpatients’ and/or tumors’ characteristics and RT performed and(ii) whether the type of RT does influence perioperativeoutcomes after PN, harnessing the newly proposed Surface-Intermediate-Base (SIB) margin score as a standardizedreporting system. Materials and Methods: After InstitutionalReview Board’s approval, data were prospectively collectedfrom a cohort of 507 patients undergoing NSS at 16 high-volume Centers across the U.S. and Europe over a 6-monthenrollment period. RT was classified according to the SIBscore. RS was classified as “enucleative”, “enucleoresective”or “resective” according to the most prevalent RT performedin each centre’s cohort. Descriptive and comparative analyseswere performed in the six enucleoresective RS centres (ERC).Results: Overall, 507 patients were finally enrolled in the study.The RT was classified as pure or hybrid enucleation (E, SIB 0-2), pure or hybrid enucleoresection (ER, SIB 3-4) and resection(R, SIB 5) in 266 (52.5%), 150 (29.6%) and 91(17.9%)patients, respectively, in the overall cohort, while in 53(33.1%), 83 (51.9%) and 24 (15.0%) patients in the ERC.Demographic data, comorbidity scores, surgical indication andapproach and PADUA score did not significantly differbetween the E, ER and R groups in the ERC. Tumors >4.0 cmwere 21 (40.4%), 41 (49.4%) and 4 (16.7%) in the E, ER andR groups (p=0.02), respectively. A clampless strategy was usedin 19.2%, 13.2% and 8.3% of patients (p>0.05). Median warmischemia time (WIT) was 19 (15-24), 17 (14-23) and 17 (15-21) minutes in the E, ER and R groups (p>0.05). Surgical post-operative complications were recorded in 7.5%, 13.2% and4.2% of patients (p=0.05). Positive surgical margin rate was7.0%, 13.4% and 0% of patients, respectively (p>0.05).Trifecta outcome was achieved in 67.2%, 71.6% and 73.7% ofpatients for the E, ER and R groups (p>0.05). Discussion andConclusions: This is the first study evaluating pre-operativepredictive factors of RTs performed during PN and whether thetype of RT significantly impacts on NSS outcomes using astandardized instrument of reporting. Overall, in ERC, ERrepresents less than 52%. ER and E are performed in asignificantly higher proportion of tumors >4 cm compared toR. Relating to surgical outcomes, ER was associated with asignificantly higher rate of post-operative surgical complicationcompared to E and R. However, Trifecta achievement wascomparable among the three techniques.85RESECTION TECHNIQUES FOR NEPHRONSPARING SURGERY VARY: INSIGHTS FROM APROSPECTIVELY COLLECTED MULTI-INSTITUTIONAL COHORT HARNESSING THESURFACE-INTERMEDIATE-BASE (SIB) MARGINSCORE (SIB INTERNATIONAL CONSORTIUM)Andrea Minervini1, Riccardo Campi1, Andrea Mari1, Ottavio De Cobelli2, Francesco Sanguedolce3, Georgios Hatzichristodoulou4, Alessandro Antonelli5, Brian Lane6, Bulent Akdogan7, Umberto Capitano8, Martin Marszalek9, Alessandro Volpe10, Nihat Karakoyunlu11, Hans Langenhuijsen12, Tobias Klatte13, Oscar Rodriguez-faba14, Sabine Brookman-may15, Marco Roscigno16, Robert G. Uzzo17, Alberto Lapini1, Marco Carini1 and Alexander Kutikov171Department of Urology, University of Florence, CareggiHospital, Florence, Italy, Firenze (FI), Italy;2Department of Urology, European Institute of Oncology (IEO), Milan, Italy;3Department of Urology, Southmead Hospital-North Bristol NHS Trust, Bristol, U.K.;4Department of Urology, Technical University of Munich,University Hospital Klinikum Rechts Der Isar, Munich, Germany;5Department of Urology, University of Brescia, Brescia, Italy;6Department of Urology, Spectrum Health Cancer Center, Grand Rapids, MI, U.S.A.;7Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey;8Department of Urology, Vita-Salute San RaffaeleUniversity, IRCCS San Raffaele Scientific Institute, Milan, Italy;9Department of Urology and Andrology, Donauspital, Vienna, Austria;10Department of Urology, Maggiore Della Carità Hospital,University of Eastern Piedmont, Novara, Italy;11Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey;12Department of Laparoscopy, Robotics and Endourology,Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands;13Department of Urology, Medical University of Vienna, Vienna, Austria;14Department of Urology, Fundacio Puigvert, Barcelona, Spain;15Department of Urology, Ludwig Maximilians University, Munich, Germany;16Department of Urology, AO Papa Giovanni XXIII, Bergamo, Italy;17Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, U.S.A.Introduction/Aim: Resection methodology is rarely reported incurrent nephron-sparing surgery (NSS) literature. Yet, aAbstracts of the 26th Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 9-11 June, 2016, Florence, Italy2603relationship between resection technique (RT) andcomplication rates, preserved parenchymal volume, surgicalmargins and oncologic outcomes likely exists. The aim of thestudy was to evaluate the newly proposed Surface-Intermediate-Base (SIB) margin score as a standardizedreporting system of RT in a cohort of patients undergoing NSSat 16 high-volume Centers across the U.S. and Europe.Materials and Methods: After Institutional Review Board’sapproval, data were prospectively collected over a 6-monthenrollment period. Results: A total of 507 patients were finallyenrolled in the study. The mean number of patients includedper center was 32 (range=11-90). A mix of open (150, 29.4%),laparoscopic (67, 13.2%) and robotic (290, 57%) approacheswere harnessed for NSS. The median interquartile range (IQR)of pre-operative tumor size for the entire cohort was 3.10 cm(2.50-4.30). Based on the PADUA score, 195 (38.5%), 188(37.1%) and 114 (22.5%) tumors were classified as low(PADUA 6-7), moderate (PADUA 8-9) and high (PADUA 10-13) complexity tumors, respectively. At pathological analysis,30 (5.9%) positive surgical margins were recorded. Overall,the Trifecta outcomes (defined as absence of perioperativecomplications, negative surgical margins and warm ischemiatime (WIT)<25 min) were achieved in 370 (73%) of patients.A snapshot of RTs performed in the entire cohort accordingto the SIB margin score is presented in Figure 1. The overallRT was classified as pure enucleation (SIB 0-1), hybridenucleation (SIB 2), pure enucleoresection (SIB 3), hybridenucleoresection (SIB 4) and resection (SIB 5) in 174(34.3%), 92 (18.1%), 106 (20.9%), 44 (8.7%) and 91 (17.9%)patients, respectively. Conclusion: Standardized reporting ofresection technique is lacking in the current NSS literature.We recently introduced a standardized scoring system, the SIBmargin score, which quantitates the salient aspects of resectionapproaches after PN through a visual analysis of the intrarenalportion of the specimen immediately after surgery. Harnessingthis systematic characterization of renal mass RTs, in aninternational multi-institutional cohort, we -for the first time-demonstrated that resection approaches vary and renal tumorANTICANCER RESEARCH 36: 2535-2628 (2016)2604Figure 1. Snapshot of RTs performed in the entire cohort according to the SIB margin score is presented.enucleation is employed quite frequently even at institutionsthat do not support its ubiquitous use. These data lay thegroundwork for determining whether RT is a modifiablevariable for functional and oncologic outcomes in patientswho undergo NSS. 86ENDOSCOPIC ROBOT-ASSISTED SIMPLEENUCLEATION (ERASE) VS. OPEN SIMPLEENUCLEATION (OSE) FOR THE TREATMENT OFCLINICAL T1 RENAL MASSES: ANALYSIS OFPREDICTORS OF TRIFECTA OUTCOMEMatteo Bonifazi, Andrea Mari, Francesco Sessa, Riccardo Campi, Tommasi Chini, Davide Vanacore,Riccardo Tellini, Mauro Gacci, Alberto Lapini, Lorenzo Masieri, Graziano Vignolini, Sergio Serni, Marco Carini and Andrea MinerviniDivision of Urology, Department of Urology, CareggiHospital, University of Florence, Florence (FI), ItalyAim: The aim of this study was to analyse the intra- and post-operative complications, as well as the predictive factors ofTrifecta outcome in patients submitted to endoscopic robot-assisted simple enucleation (ERASE) and open simpleenucleation (OSE) for clinical T1 renal masses. Materials andMethods: Overall, 634 cases treated with OSE (n=290) andERASE (n=344) were prospectively recorded in ourDepartment between 2006 and 2014. Trifecta was defined assimultaneous ischemia time <25 min, no surgicalcomplication and negative surgical margin. A univariateanalysis and multivariate logistic regression were performedfor Trifecta. Results: The two groups were comparable forbody mass index (BMI), comorbidity, tumor side, clinical Tscore, tumor diameter, surgical indication, pre-operative renalfunction, pre-operative hemoglobin and hematocrit. Asignificant difference was found between the OSE and theERASE groups in operative time (115 (96-130) vs. 150 (120-180) minutes, p<0.0001), pedicle clamping (93.8% vs.69.2%, p<0.0001), estimated blood loss (EBL) (150 (100-200) vs. 100 (100-143) cc, p<0.0001) and intraoperativecomplications (3.4% vs. 1.7%, p=0.02). The two groups werecomparable for warm ischemia time (WIT) ≥25 min. Asignificant difference was found between OSE and ERASEin overall (16.6% vs. 5.5%, p<0.0001), Clavien 2 (11.7% vs.4.4%, p=0.02) and Clavien 3 (3.1% vs. 1.7%, p=0.04) post-operative surgical complications, length of stay (6.0 (5.0-7.0)vs. 5.0 (4.0-6.0) days, p<0.0001), pre-operative 1st day deltacreatinine (0.3 (0.2-0.4) vs. 0.15 (0.1-0.2) mg/dl, p<0.0001),positive surgical margins (2.1% vs. 1.5%, p=0.04), andTrifecta achievement (73.8% vs. 85.5%, p<0.0001). Atunivariate analysis, a higher median clinical diameter, ahigher mean age, a higher median Charlson comorbidityindex (CCI), endophytic tumor growth pattern, renal sinusand calyceal dislocation of the tumor, a higher medianPADUA score and OSE were predictive factors of Trifectaachievement. At multivariate analysis, CCI lost significance(p=0.26), while age (odds ratio (OR)=1.02, 95% confidenceinterval (95% CI)=1.00-1.04, p=0.001), clinical diameter(OR=1.22, CI=1.05-1.42, p=0.008), PADUA score (OR=1.23,CI=1.07-1.41, p=0.004) and OSE (OR=1.74, CI=1.13-2.68,p=0.01) were confirmed predictive factors for Trifecta failure.Conclusion: The ERASE is a feasible and safe technique,which shows a comparable WIT, together with a significantlylower EBL, surgical complications’ rate, length of stay and asignificantly higher Trifecta achievement compared to OSE.Age, comorbidity, tumor diameter and PADUA score, inassociation with surgical approach, represent significantpredictive factors of Trifecta failure.87PROSPECTIVE ANALYSIS OF COMPLICATIONSAND THEIR PREDICTIVE FACTORS AFTERPARTIAL NEPHRECTOMY IN A MULTICENTERCOMPARATIVE ITALIAN STUDY (RECORD1)Andrea Mari1, Andrea Minervini1, Alessandro Antonelli2,Riccardo Bertolo3, Giampaolo Bianchi4, Marco Borghesi5,Cristian Fiori3, Nicola Longo6, Giuseppe Martorana5,Vincenzo Mirone6, Giuseppe Morgia7, Giacomo Novara8,Francesco Porpiglia9, Bruno Rovereto10, Riccardo Schiavina5, Sergio Serni1, Francesco Sessa1,Claudio Simeone2, Mario Sodano2, Riccardo Tellini1, Carlo Terrone11 and Marco Carini11Division of Urology, Department of Urology, CareggiHospital, University of Florence, Florence, Italy;2Department of Urology; Azienda AO Spedali Civili Di Brescia, Italy;3Department of Urology, University of Turin, Ospedale San Luigi Gonzaga, Orbassano, Italy;4Policlinico Di Modena, Department of Urology, University of Modena, Italy;5Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy;6Urology Department, University Federico II of Naples, Via S.Pansini, Naples, Italy;7Luna Foundation, Roma, Italy;8Department of Urology, University of Padua, Padua, Italy;9Department of Urology, University of Turin, Ospedale San Luigi Gonzaga, Orbassano, Italy;10I.R.C.C.S. Policlinico San Matteo, Department of Urology, Pavia, Italy;11Urology, Maggiore Della Carità University Hospital,University of Eastern Piedmont, Novara, ItalyAbstracts of the 26th Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 9-11 June, 2016, Florence, Italy2605

RESECTION TECHNIQUES FOR NEPHRON SPARING SURGERY VARY: INSIGHTS FROM A
PROSPECTIVELY COLLECTED MULTIINSTITUTIONAL COHORT HARNESSING THESURFACE-INTERMEDIATE-BASE (SIB) MARGIN SCORE (SIB INTERNATIONAL CONSORTIUM)

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RESECTION TECHNIQUES FOR NEPHRON SPARING SURGERY VARY: INSIGHTS FROM A

PROSPECTIVELY COLLECTED MULTIINSTITUTIONAL COHORT HARNESSING THESURFACE-INTERMEDIATE-BASE (SIB) MARGIN SCORE (SIB INTERNATIONAL CONSORTIUM)

RESECTION TECHNIQUES FOR NEPHRON SPARING SURGERY VARY: INSIGHTS FROM A PROSPECTIVELY COLLECTED MULTIINSTITUTIONAL COHORT HARNESSING THESURFACE-INTERMEDIATE-BASE (SIB) MARGIN SCORE (SIB INTERNATIONAL CONSORTIUM)

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