PD64-02 SURVIVAL AFTER MINIMALLY INVASIVE VERSUS OPEN RADICAL NEPHRECTOMY FOR STAGE I AND II RENAL CELL CARCINOMA

Abstract

INTRODUCTION AND OBJECTIVE: A phase III randomized trial comparing open and minimally invasive hysterectomy showed significantly higher rates of local recurrence after minimally invasive surgery (MIS) for cervical cancer. This raised concerns regarding patterns of recurrences after MIS in general. This study aims to determine the effect of MIS on all-cause mortality among patients undergoing radical nephrectomy (RN) for renal cell carcinoma (RCC). METHODS: We utilized the National Cancer Database to identify patients diagnosed with clinical stage I and II RCCs between 2010 and 2013. Patients for whom a laparoscopic or robotic RN was attempted (including patients whose surgery was converted to open) were compared to patients who underwent open radical nephrectomy (ORN). Multivariable adjusted regression models with inverse probability propensity score weighting (IPW) were utilized to identify independent predictors of receiving MIS. All-cause mortality rates were compared using IPW survival functions and log-rank tests. Multivariable weighed Cox proportional hazard models were fitted to determine independent predictors of OS. RESULTS: Overall, 27,642 patients were identified; 11,524 (41.7%) had MIS, while 16,118 (58.3%) had an ORN. Treatment at academic centers (odds ratio [OR] 1.76, 95% confidence interval [CI] 1.62e1.91, p<0.001) and having highest quartile median household income (OR 1.41, 95% CI 1.3e1.53, p<0.001) were associated with an increased likelihood of having MIS. Conversely, African American race (OR 0.88, CI 0.81e0.95, p=0.001) and clinical T2 disease (OR 0.58, 95% CI 0.55e0.61, p<0.001) were associated with a decreased likelihood of having MIS. At a median follow up of 44.7 months, Kaplan Meier survival curves in the propensity score weighed cohort showed OS advantage for patients who underwent MIS (HR 0.84, 95% CI 0.8e0.87, p<0.001) (Table 1). Furthermore, length of hospital stay (3 vs. 4 days), 30-day readmission rates (2.4% vs. 2.87%), 30-day mortality rates (0.53% vs. 0.96%) and 90-day mortality rates (1.04% vs. 1.77%) were significantly higher in the ORN group (p<0.001). CONCLUSIONS: After propensity score weighing, MIS was associated with better 3-year overall survival compared to ORN for stage I and II RCC. Additionally, MIS had lower post-operative readmission, 30- and 90-day mortality rates.