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Purpose: We sought to evaluate outcomes of lymph node dissection (LND) in patients with upper tract urothelial carcinoma. Materials and Methods: We performed a multicenter retrospective analysis utilizing the ROBUUST (for RObotic surgery for Upper Tract Urothelial Cancer Study) registry for patients who did not undergo LND (pNx), LND with negative lymph nodes (pN0) and LND with positive nodes (pND). Primary and secondary outcomes were overall survival (OS) and recurrence-free survival (RFS). Multivariable analyses evaluated predictors of outcomes and pathological node positivity. Kaplan-Meier analyses (KMAs) compared survival outcomes. Results: A total of 877 patients were analyzed (LND performed in 358 [40.8%]/pND in 73 [8.3%]). Median nodes obtained were 10.2 for pND and 9.8 for pN0. Multivariable analyses noted increasing age (OR 1.1, p <0.001), pND (OR 3.1, p <0.001) and pathological stage pTis/3/4 (OR 3.4, p <0.001) as predictors for all-cause mortality. Clinical high-grade tumors (OR 11.74, p[0.015) and increasing tumor size

334 Background: IO, either as combination therapy in the frontline or monotherapy in the second line, has improved outcomes for patients with advanced RCC. With the movement away from upfront CN, limited data are available on the outcomes of patients who receive IO with delayed CN. In this study, we characterized the pathologic and survival outcomes for patients who received IO followed by CN. Methods: We conducted a multi-center, retrospective analysis of patients with advanced/metastatic RCC having received IO combination or monotherapy followed by CN. An IRB-approved and HIPAA-compliant registry was used to collect data from the electronic medical record. Our primary endpoint was the degree of pathologic downstaging comparing baseline clinical T stage to pathologic T stage following IO. Secondary endpoints included investigator assessed response using RECIST principals, progression-free survival (PFS), and overall survival (OS). Results: We identified53 patients with advanced RCC across 9 institutions who were eligible for the study. The median age was 63 years, 72% were white, and 60% were male. 81% of patients had clear cell histology, 11% had sarcomatoid differentiation, and 75% presented with de novo metastatic disease. Baseline IMDC risk is as follows: 4% favorable, 55% intermediate, and 26% poor risk with 15% unknown. 23% had bone metastases and 23% had liver metastases at baseline. Lines of therapy prior to CN was 1 line in 74% of patients, 2 lines in 25%, and 3 lines in 2%. For the line of IO therapy immediately preceding CN, 49% received nivolumab+ipilimumab, 30% received IO monotherapy, and 21% received combination IO/VEGF therapy. The median duration of therapy prior to surgery was 11.3 months (range 0.38-47.8). 28% of patients discontinued treatment after CN for observation. Best overall response prior to CN was stable disease in 25% of patients, partial response in 60%, and progressive disease in 4% with 11% unknown. Following receipt of IO-based treatment, 38% of patients exhibited downstaging from the baseline clinical T stage to the CN pathological T stage (Table). 11% of patients had no residual disease at CN. For pathologic outcomes, 85% of patients had negative margins, 75% had necrosis present, and the median tumor size at CN was 6.5 cm. The median PFS was 11.3 months and median OS was 25.7 months for the overall cohort. Conclusions: IO-based strategies demonstrate efficacy in the renal primary in patients with advanced RCC. T stage downstaging was demonstrated in 38% of patients with 11% having a complete pathologic response in the renal primary following IO administration. Biomarker studies on baseline and CN tissue will further elucidate molecular predictors of response and resistance to IO therapy.[Table: see text]

To present the feasibility and technical details of robot-assisted single port partial nephrectomy with a retroperitoneal approach, using da Vinci SPÒ platform.METHODS: Between April and July 2019, 2 patients (1 male) with renal mass (both right side) underwent robot-assisted single port retroperitoneal partial nephrectomy. Both patients had organ confined disease with lower pole 24 and 25 mm renal masses (Nephrometry score: 4p and 6p). Patients were positioned in 90 degree flank position and a 30 mm transverse incision was made between the 12th rib and the iliac crest at the level of the mid axillary line. The retroperitoneal space is initially identified and created by digital exploration, followed by balloon dilation to create an appropriate working space. The inner ring of the alexis wound retractor was inserted in the retroperitoneal space, and the GelPOINT Mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA) was assembled. A 25 mm multichannel robot port and a 12-mm accessory laparoscopic port were passed through the GelPOINT and the da Vinci SPÒ Surgical System (Intuitive Surgical, Sunnyvale, CA) was docked. Standard partial nephrectomy with early unclamping technique and renorrhaphy in two layers was performed. The specimen was extracted through the trocar site and no drain was placed.RESULTS: Patients' age was 58 and 78 years. Both cases were completed successfully without any need for conversion, blood transfusion or intraoperative complications. Operative times were 155 and 240 minutes, with warm ischemia times of 26 and 29 minutes. Postoperative course was uneventful and patients were discharged after 26 and 42 hours of hospital stay. In-hospital analgesia included exclusively nonsteroidal anti-inflammatory drugs. Histopathological examination of specimens showed a 21 mm clear cell renal cell carcinoma and a 26 mm benign papillary adenoma, both with negative margins.CONCLUSIONS: Single-port partial nephrectomy through retroperitoneal approach is feasible in selected patients by Using da Vinci SPÒ platform is feasible. This system has features such as double-jointed articulating robotic instruments and the articulating camera that allow to optimize the work in a smaller environment such the retroperitoneal space. With avoiding violation of the peritoneum, promising results regarding pain control, the need for opioid usage and postoperative recovery can be expected. Further comparative studies with larger sample and long-term follow-up data are recommended to corroborate these initial findings.