Mp37-18 oncologic Outcomes After Robot-Assisted Radical Nephroureterectomy for Upper Urinary Tract Malignancy

Abstract

INTRODUCTION AND OBJECTIVES: Open partial nephrectomy (OPN) is considered the gold standard treatment for patients with renal tumours in solitary functioning kidneys. The ability to offer satisfactory cancer outcomes combined with potential avoidance of long term dialysis drives this treatment. However in some cases an OPN is technically not possible, due to size, location within the kidney and together with concerns about the oncological safety of a partial nephrectomy in stage T2 or higher disease. The conventional management has been a radical nephrectomy which renders these patients anephric and dialysis dependent.Since 2005, renal autotransplantation (EPN) for renal cell cancer has been carried out in Oxford for masses that would not historically have been considered suitable for nephron-sparing surgery. The program received national commissioning in the UK from 2012, the only urological procedure to be considered suitable for this at the time.METHODS: 36 patients in the UK have been assessed in the renal autotransplant program in Oxford between 2005-2018 and subsequently undergone a renal autotransplant. The patients were either recruited from within region or throughout the United Kingdom through national commissioning. RESULTS: Number of Patients treated [ 36 ( 24 M: 12F) Mean Age 64 (37-82) Renal history: Solitary Kidney [ 25 Bilateral Cancer [ 8 Non-functioning contralateral kidney [ 3 Tumour size 6.2 cm (2.6-18 cm) Single tumour [ 31 Multi-focal disease [ 5 R.E.N.A.L. Nephrometry score Highly complex [ 34 Moderately complex [ 2 Peri-operative outcomes Positive Surgical Margins 2/36 (5.5%) Post operative dialysis 18/36 (50%) Complications (Clavien III-V) 20/36 (56%) 30 day mortality 2/36 (5.6%) Long term outcomes Duration of Follow up: Mean [ 60 months (6-156) Cancer Specific Survival 96% Recurrence free Survival 79% Overall Survival 88% Dialysis free survival 83% of patients still alive CONCLUSIONS: EPN though complex and potentially hazardous offers an excellent chance of renal preservation without compromising cancer control EPN should be considered a viable treatment option in selected patients