Abstracts from the Mid-Atlantic Section of the AUA 2020

MA AUA 2020 Abstracts Does the Timing of Preoperative Imaging Make a Difference in the Surgical Management of Advanced Renal Cell Carcinoma with Venous Extension? A. Hajiran; D. Zekan; A. Elbakry; M. Ost; M. Salkini; A. Luchey West Virginia University Department of Urology, Morgantown, WV, USA Introduction: Advanced renal cell carcinoma (RCC) can be associated with tumor thrombus formation within the renal vein, vena cava, and right atrium. Accurate preoperative assessment of the level tumor thrombus extension is important for surgical planning. The time between diagnosis and tumor thrombus progression is unclear. We sought to determine if there is an optimal window to obtain cross- sectional imaging before surgery to characterize the level of thrombus extension with the goal of minimizing unplanned intraoperative events and improving patient outcomes. Materials & Methods: We performed a retrospective analysis of patients with stage ≥ pT3 renal cancer managed with open radical nephrectomy at a tertiary care institution from March 2010 to March 2019. We reviewed patient demographics, presenting symptoms, preoperative imaging, surgical technique, intraoperative and postoperative complications, pathology, recurrence, and mortality. Results: Of the 392 cases, there were 23 patients with tumor thrombus invasion the renal vein and inferior vena cava. The median age at diagnosis was 65 years-old (range 51-82) with a male-to-female ratio of 4:1. All patients had preoperative CT scans of the abdomen and pelvis, while 73% had a dedicated MRI. The median time between cross-sectional abdominal imaging and surgery was 19 days (range 1-90). Imaging > 19 days prior to surgery was associated with a higher rate of intraoperative complications (22% vs. 0%, p = 0.014) and unplanned consultations (30% vs. 0%, 0.004). However, there were no significant differences in estimated blood loss, operative time, blood transfusions, length of stay, Clavien-Dindo grade III-IV complications, or rate of recurrence. Conclusions: The management of advanced RCC with venous extension is associated with significant blood loss, operative time, and length of stay. Obtaining preoperative imaging within 19 days surgery may capture tumor thrombus progression, allowing for better preparation with the possibility of lessening intraoperative complications and the need for unplanned intraoperative consultations. PDB-12 PDB-11 Association of Lymph Node Count and Survival After Primary Retroperitoneal Lymph Node Dissection (RPLND) for Testicular Nonseminomatous Germ Cell Tumor (NSGCT) H. Patel 1 ; A. Srivastava 1 ; S. Kim 2 ; E. Singer 1 ; T. Jang 1 1 Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood JohnsonMedical School, New Brunswick, NJ, USA; 2 Rutgers Cancer Institute of New Jersey and Rutgers School of Public Health, New Brunswick, NJ, USA Introduction: RPLND for clinical stage (CS) I & IIA/B NSGCT has both staging and therapeutic implications. Single center studies have reported on the impact of lymph node count on outcome after 1° RPLND for men with NSGCT. However, this has yet to be corroborated in a nationally representative dataset. Materials &Methods: Using the National Cancer Database, a retrospective analysis of patients who received a primary RPLND for clinical stage I and IIA/B NSGCT was performed. This cohort was stratified according to LN count (≤ 20, > 20 LNs). Sociodemographic characteristics were compared among groups. The Kaplan-Meier methodwas calculated and pairwise comparisonwas performed among each group. Multivariate analysis was performed to identify factors associated with having > 20 LNs resected during primary RPLND. Results: Of 1,376 men who received 1° RPLND for Stage I or IIA/B NSGCT, 35.6%, 27.4%, and 14% had ≤ 20, 21-40, and > 40 LNs resected, respectively. LN count was associated with overall survival (OS), with 95%, 97%, and 98% 8-year OS for men with ≤ 20, 21-40, and > 40 LNs, respectively. OS in men with ≤ 20 vs. 21-40 (p = 0.018) and > 40 LNs (p = 0.042) resected differed significantly whereas no significant difference was observed when 21-40 vs. > 40 LNs were resected (p = 0.677). Therefore, subsequent analysis compared those who had ≤ 20 and > 20 LN resected, and OS between these two groups differed significantly. Multivariate analysis demonstrated that patients with private insurance, surgery having been performed at an academic center or in the Northeast, and those with pT2 disease were more likely to have > 20 LNs resected at the time of RPLND. Conclusions: Lymph node count after primary RPLND for NSGCT is significantly associated with overall survival, with more favorable survival seen in those who receive an RPLND with > 20 LNs resected when compared to ≤ 20 LNs. Accuracy of Clinical Staging in Stage I and IIA/B Testicular Nonseminomatous Germ Cell Tumors (NSGCT) and Implications on Survival A. Srivastava 1,2 ; H. Patel 1,2 ; S. Kim 2 ; I. Kim 1,2 ; E. Singer 1,2 ; T. Jang 1,2 1 Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ, USA; 2 Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA Introduction: Clinical stage (CS) dictates treatment in men with testicular cancer and its inaccuracy may affect clinical outcome. We evaluate the clinical staging accuracy in men with CS I and CS IIA/B NSGCT and explore the survival implications of inaccurate staging. Materials &Methods: Using the National Cancer Database (NCDB), we abstracted patients with clinical Stage I-IIB NSGCT who received a primary retroperitoneal lymph node dissection (RPLND) from2004 to 2014. Primary RPLNDwas defined as RPLND performed for CS I-IIB patients without prior chemotherapy. CS was cross- tabulated with pathologic nodal staging data. Kaplan Meier estimates illustrated overall survival among those patients accurately staged (i.e. CS I patients with pN0 disease) and up-staged (i.e. CS I patients with pN+ disease). Results: Using the National Cancer Database (NCDB), we abstracted patients with clinical Stage I-IIB NSGCT who received a primary retroperitoneal lymph node dissection (RPLND) from 2004 to 2014. Primary RPLND was defined as RPLND performed for CS I-IIB patients without prior chemotherapy. CSwas cross-tabulated with pathologic nodal staging data. Kaplan Meier estimates illustrated overall survival among those patients accurately staged (i.e. CS I patients with pN0 disease) and up-staged (i.e. CS I patients with pN+ disease). Conclusions: Nearly 25% of patients with CS I NSGCT are under-staged and are found to have pN1-3 after RPLND. Nodal disease burden is associated with survival. Novel imaging techniques and biomarkers are needed to improve the sensitivity of detecting NSGCT. PDB-10 13 Podium Session B