THE JOURNAL OF UROLOGY姞
CONCLUSIONS: PN on a solitary kidney significantly is at risk of post-operative HD. Pre-operative altered renal function and clamping time are the main predictive parameters. Source of Funding: None
583 A POPULATION-BASED COMPETING-RISKS ANALYSIS OF SURVIVAL AFTER NEPHRECTOMY FOR RENAL CELL CARCINOMA Marco Bianchi*, Milan, Italy; Maxine Sun, Montreal, Canada; QuocDien Trinh, Detroit, MI; Jens Hansen, Hamburg, Germany; Zhe Tian, Montreal, Canada; Umberto Capitanio, Alberto Briganti, Milan, Italy; Shahrokh Shariat, New York, NY; Paul Perrotte, Montreal, Canada; Francesco Montorsi, Milan, Italy; Pierre Karakiewicz, Montreal, Canada INTRODUCTION AND OBJECTIVES: Competing cause of mortality has been examined in patients with localized renal cell carcinoma (RCC). However the effect of tumor grade has not been accounted for. We reassessed this topic in all RCC stages integrating tumor grade. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 42090 patients treated with NT between years 1988 and 2008. Patients were stratified in 32 strata according to age groups (ⱕ59, 60-69, 70-79, and ⱖ80 years), Fuhrman grade (I-II vs. III-IV) and American Joint Committee on Cancer (AJCC) stage which resulted in a total of 32 combinations. Competing risk Poisson analyses were performed to simultaneously assess the rates of CSM and OCM at 5 years after nephrectomy. RESULTS: Overall 11153 deaths occurred (27%). Of those, 5554 (50%) were due to CSM events. The risk of CSM and OCM at five years after nephrectomy is illustrated in Figure 1. Several findings were observed. First, amongst low-grade tumors, the highest CSM rates at five years were recorded in the youngest age group (ⱕ59 years) with AJCC stage IV RCC (63%). In contrast, the highest OCM rate at five years were recorded in the oldest age group (ⱖ80 years) with AJCC stage I RCC (33%). Not surprisingly, CSM rates increased with disease stage, while OCM rates increased with age. Second, amongst highgrade tumors, a similar trend was recorded where the highest CSM rate at five years were recorded in the youngest age group with AJCC stage IV RCC (79%), while the highest OCM rate at five years was recorded in the oldest age group with AJCC stage I RCC (44%). Finally, it is also noteworthy tumor grade was not particularly detrimental amongst patients with AJCC stage I RCC, especially in the elderly. For example, the five-year CSM rate in patients aged ⱕ80 years with AJCC stage I RCC was 7% for low-grade vs. 8% for high-grade disease. In contrast, for the same stage, the five-year CSM rate in patients aged ⱕ59 years was 2% for low-grade vs. 6% for high-grade disease. CONCLUSIONS: Our study provides a valuable graphical aid for prediction of CSM, and OCM, according to patient age, disease stage and grade in patients treated with NT for RCC, and this can help clinicians to better stratify the risk-benefit ratio of NT.
Source of Funding: None
Vol. 187, No. 4S, Supplement, Sunday, May 20, 2012
584 COMPARING COSTS OF ROBOTIC, LAPAROSCOPIC, AND OPEN PARTIAL NEPHRECTOMY Mehrdad Alemozaffar*, Steven Chang, Ravi Kacker, Maryellen Sun, William DeWolf, Andrew Wagner, Boston, MA INTRODUCTION AND OBJECTIVES: Laparoscopic and robotic partial nephrectomy (LPN and RPN) are common minimally invasive alternatives to open partial nephrectomy (OPN) for management of renal tumors. Cost discrepancies of these approaches warrants evaluation. We compared hospital costs associated with RPN, LPN, and OPN at a tertiary care teaching institution. METHODS: Variable costs (VC) included operating room (OR) time, supplies, anesthesia, inpatient care, radiology, pharmacy, and laboratory costs. Fixed costs (FC) included equipment purchase and maintenance. VC and FC were captured for 25 patients in each group who underwent RPN, LPN, OPN at our institution between November 2008 through September 2010. The impact of VC and FC were estimated using various sensitivity analysis. RESULTS: We found similar VC for RPN, LPN, and OPN ($6,375 vs $6,075 vs $5,774, p⫽0.116, respectively). OR supplies contributed greater cost for RPN and LPN than OPN ($2,179 vs. $1,987 vs. $181, p⬍0.0001, respectively), while the inpatient stay cost was higher for OPN compared to LPN and RPN ($2,418 vs. $1,305 vs. $1,274, p⬍0.0001, respectively). (Fig 1) Sensitivity analysis for VC demonstrated that RPN and LPN can be less costly than OPN (with OPN parameters held constant) if the average hospital stay for RPN and LPN is ⬍2 days and OR time is ⬍204 and 196 minutes, respectively. (Fig 2) When FC are included, cost equivalence of RPN and LPN to OPN requires even shorter operative times and length of stay, with increased utilization of RPN and LPN equipment. (Fig 3). CONCLUSIONS: There was no difference among VC for RPN, LPN, and OPN at our institution. By minimizing OR time and length of hospital stay, it is possible for RPN and LPN to be cost equivalent to OPN. With FC included, RPN and LPN were more costly than OPN, but equivalence may be possible with improvements in efficiency and utilization.
Source of Funding: None