Abstracts from the Abstracts from the Mid-Atlantic Section of the AUA 2021

MA-AUA 2021 Abstracts Moderated Poster Session 4: Kidney/Bladder/Penile/Testicular/ Adrenal Cancer MP4-07 Robotic-Assisted Laparoscopic Approach to Radical CystectomyMitigates Surgical Complications in Patients with Preoperative Malnutrition C. Adams-Mardi, M. Whalen George Washington University School of Medicine and Health Sciences, Washington, DC, USA Introduction and Objective: Preoperative malnutrition raises clinical concern for complications following radical cystectomy (RC) in the treatment of muscle-invasive bladder cancer. A robotic, laparoscopic approach to RC, based on its reduced perioperative morbidity, could be preferable for patients with nutritional deficits. Prior studies have not explored the effect of a robotic approach on malnourished patients. This investigation will evaluate the associations of robot-assisted surgical approach with perioperative and 30-day postoperative complications after RC. It will also evaluate the effects of preoperative malnutrition and hypoalbuminemia on perioperative and 30-day postoperative complications after RC. Methods: Retrospective review of ACS-NSQIP identified patients who underwent RC with postoperative diagnosis of bladder cancer and non- disseminated disease (2005-2018). Surgical approach was categorized as open vs. robotic / laparoscopic. Malnourishment was defined as either having low serum albumin (<3.5 g/dL), 10% 6-month preoperative weight loss, or BMI <18.5 kg/m2. Multivariable logistic regression and generalized linear models were used for categorical and continuous outcomes, respectively, to characterize the association between robotic approach and 30-day perioperative/. postoperative complications followingRC compared to non-robotic operations. Results: Malnourishment was associated with greater preoperative transfusions, systemic sepsis, peri-postoperative bleeding transfusion, 30-day mortality, postoperative C. difficile infection rate, and hospital length of stay. In malnourished patients: robotic approach was associated with lower adjusted odds of bleeding transfusions (aOR=0.51) and fewer adjusteddays fromoperation to discharge (Beta[SE]= -5.2[1.1]) compared to open (all respective p<0.05). Conclusions: Robotic-assistedapproach toRCmitigated twomajorpostoperative complications associatedwithmalnutrition: bleeding transfusions anddays from operation to discharge. Further improvements in perioperative pathways are needed to optimize the treatment of malnourished patients undergoing radical cystectomy, especially given the observed association with other high risk comorbidities. These findings highlight the fact that a robotic approach to RC may be preferable for patients with preoperative nutritional deficits. Physicians’ Knowledge About Pembrolizumab for High-Risk Non- Muscle Invasive Bladder Cancer: Quality Improvement Targets in Multidisciplinary Cancer Care R. Talwar 1 , C. Sperling 1 , L. Xia 1 , C. Herrera 1 , R. Parikh 2 , D. Lee 1 , T. Guzzo 1 , R. Mamtani 2 1 University of Pennsylvania - Division of Urology, Philadelphia, PA, USA; 2 University of Pennsylvania - Division of Hematology/Oncology, Philadelphia, PA, USA Introduction and Objective: In 2020, pembrolizumab received accelerated approval for treatment of BCG-unresponsive CIS +/- papillary disease (high-grade Ta or T1 tumors) for patients ineligible for or who have elected to forego radical cystectomy (RC). Practical considerations of pembrolizumab utilization after this approval have not been well described. Methods: We assessed urologists’ andmedical oncologists’ level of awareness of pembrolizumab for treatment of high-risk non-muscle invasive bladder cancer (HR-MIBC) and data supporting its use. Using snowball sampling via Twitter and targeted emails from 12/2020-1/2021, we administered an online survey assessing understanding and patterns of utilization of pembrolizumab for HR-NMIBC. Results: Fifty providers who treat NMIBC completed the questionnaire; 66% (n=33) were urologists, and 34% (n=17) were medical oncologists. Nearly 75% (n=37) prescribed pembrolizumab for HR-MIBC or referred a patient for treatment. Most commonly cited reason for choice of pembrolizumab over RC was patient refusal rather than RC ineligibility. Nearly one-third (32%, n=16) failed to correctly identify the FDA approved indication for prescribing pembrolizumab; nearly two-thirds (64%, n=32) were unable to recognize the FDAdefinition of BCG unresponsive NMIBC as “persistent or recurrent CIS, with or without recurrent Ta/T1 disease within 12 months of completing BCG.” The majority of our cohort over-estimated true response rate or duration of response to pembrolizumab (46% [n=23] provided the correct one-year complete response rate of 18%). No differences in knowledge assessment answers were noted by specialty. Conclusions: The use of systemic immunotherapy in a historically surgeon-driven management pathway presents a unique challenge for both urologists and oncologists. We identify gaps in knowledge that may lead to overutilization and overestimation of benefit. Our findings provide insight into physician adherence to treatment guidelines and tangible quality improvement targets. MP4-06 27