Abstracts from the New England Section of the AUA 2021

© The Canadian Journal of Urology TM : International Supplement, October 2021 Scientific Session I: Oncology I Impact of TobaccoUse on PostoperativeMorbidity andMortality Following Surgery for Renal Masses Kevin R. Melnick, MD 1 , Kendrick Yim, MD 1 , Madhur Nayan, MD 1 , Matthew Mossanen, MD 1 , Felipe Carvalho, MD 1 , Wesley Chou, BS 2 , Benjamin I. Chung, MD 3 , Steven L. Chang, MD 1 1 Brigham and Women’s Hospital, Boston, MA, USA; 2 Harvard Medical School, Boston, MA, USA; 3 Stanford University, Stanford, CA, USA Introduction: Tobacco use has been shown to be an independent risk factor for postoperative morbidity following a variety of major surgeries. While tobacco use is both a risk factor for kidney cancer and associated with worse long-term survival, there is minimal data regarding its association with postoperative complications following nephrectomy. Materials &Methods: We performed a retrospective cohort study of patients undergoing nephrectomy for renal masses between 2003-2017 using the Premier Hospital Database, a discharge dataset representing approximately 20% of non-federal hospitalizations in the United States. Using multivariable logistic regression analyses (MVA), we evaluated the association between tobacco use and the risk of 90-day postoperative complications as defined by the Clavien classification system, adjusting for patient demographics and comorbidities, hospital characteristics, and disease status. We completed subgroup analyses of surgical approach (open vs. minimally-invasive; radical vs. partial), and assessed postoperative complications by system. Results: 108,430 patients were included in the analysis. 34,368 (31.7%) were identified as tobacco consumers, who were more likely to be male and harbor higher comorbidity indices. On MVA, tobacco consumption was associated with a significantly increased risk of minor complications (Clavien grades 1-2, OR 1.17, 95%CI 1.14-1.21) and non-fatal major complications (Clavien grades 3-4, OR 1.28, 95%CI 1.21-1.35), but no difference with respect to postoperative mortality (OR 0.93, 95%CI 0.79-1.11). Similar results were seen on all subgroup analyses by surgical approach ( Figure 1 ). Within complications by system, our analysis demonstrated an association between tobacco use and increased surgical, pulmonary, urologic, infectious, renal, gastrointestinal, and cardiac complications ( Figure 2 ). Conclusions: Tobacco consumption is associatedwith significantly increased risk of minor and non-fatal major post-operative complications in patients undergoing nephrectomy for renal masses regardless of surgical approach, with the strongest association for surgical, pulmonary, and urologic complications. It is therefore appropriate to encourage tobacco cessation among patients planning to undergo kidney surgery in an effort to optimize postoperative outcomes. Early Experience and outcomes with Robotic retroperitoneal lymph node dissection Da David Jiang, MS, MD, MJ Counsilman, MD , Joseph Black, MD, Allison Kleeman, BS, AdrianWaisman, MD, Catrina Crociani, MS, Peter Chang, MPH MD, Boris Gershman, MD, Andrew A. Wagner, MD Beth Israel Deaconess Medical Center, Boston, MA, USA Introduction: Retroperitoneal lymph node dissection (RPLND) remains a standard of care option in the management of early stage testicular cancer and in the setting of for post-chemotherapy NSGCT with residual retroperitoneal mass. As robotic expertise with complex surgery improves, more teams have embraced this approach which offers the promise of lower morbidity than a standard, open approach via midline incision. We present our single institution experience with robotic RPLND for testis cancer as well as a video illustration of our technique. Materials & Methods: All robotic RPLND were performed by either two- fellowship trained urology attendings or an attending and fellow. Patients were positioned in a modified lateral position and either the Si or the Xi Da Vinci robot was used. Bilateral template dissection was performed for all post-chemotherapy RPLND (PC-RPLND) cases and required re-positioning and re-docking, a process made easier with the Xi robot. For one bilateral template post-chemotherapy case we used the ‘reverse prostate’ position with the robot docking over the patient’s head and patient supine and in Trendelenberg. For stage I disease, the decision for bilateral or unilateral template dissection was individualized for each patient. Results: A total of 14 patients underwent robotic RPLND from 2016 to 2020. Patient demographics and perioperative outcomes are highlighted in the Table . Of note, 64% of patients underwent primary RPLND while 36% were in the post-chemotherapy setting. Median operative time for unilateral cases was 4.4 hrs (IQR 4.4-4.6) and for bilateral cases was 6.2 hrs (4.8-7.8). Estimated blood loss (EBL) was 100mL (IQR 63-213) and the median hospital stay was 2 days (IQR 1-2). Overall, 4 patients experienced complications within 90 days and the highest was Clavien Dindo 2--abdominal pain with emergency room visit which was assumed due to pancreatitis from passing a gallstone. One late complication occurred beyond 90 days post-op: a patient presentedwith a unilateral ureteral stricture, which was successfully managed endoscopically with dilation. None of the patients in the primary RPLND setting had positive nodes however 4 patients in the PC-RPLND setting had positive nodes (3 with teratoma and 1 with residual germ cell tumor who received further chemotherapy). All patients are without recurrence at a median follow-up of 24 (IQR 6.3-42) months. Of those that we were able obtain information on antegrade ejaculation (n = 9), six patients (67%) retained ejaculation. Of the three patients without antegrade ejaculation, all were in patients undergoing PC-RPLND. Conclusions: Robotic RPLND is safe and feasible in both primary and post-chemotherapy settings in properly selected patients, with shortened convalence compared to the open approach. Early experience suggests a low rate of perioperative complications and excellent oncologic outcomes. 10 9 6