Munich, Germany (UroToday.com) In today’s “tips and tricks” poster session for kidney cancer, Dr. Campi and colleagues presented their multi-institutional work on predictive factors of resection techniques among “enucleative” centers. The investigators utilized the novel “Surface-intermediate-base” standardized scoring system for assessing kidney cancer resections in 507 patients from 16 institutions on a prospective basis.
The classification scheme involved SIB score 0-2 for enucleation (n= 266, 52.5%), 3-4 for enucleoresection (n=150, 29.6%), and 5 for resection (n=91, 17.9%). Among centers that most commonly perform enucleations (i.e. enucleative centers), there were 207 (74.7%) enucleations, 56 (20.2%) enucleoresections, and 14 (5.1%) resections. Although statistically significant, complexity varied little among the groups as median PADUA score was 8 for enucleations, and 9 for all other cases (p=0.03). Surgery was performed without hilar clamping in 38.7% (79/204) of enucleations, 10.9% (6/55) of enucleoresections, and 35.7% of resections (5/14, p<0.001). For those cases that included hilar clamping, there were no differences in length of clamp time across SIB groups. There were also no differences in positive margin rates (2.4% in enucleation, 7.4% in enucleoresection, 0% in resection) or complications (6.8%, 12.5%, 14.2%) across the groups.
The authors concluded that enucleation makes up approximately 75% of partial nephrectomy resections in enucleative institutions. Off-clamp approach was more commonly associated with enucleations than enucleoresections or resections in these centers. More conservative resection strategy (ER and R) is associated with higher complexity cases. Complications, clamp times, positive margin rate, and complications were similar regardless of resection technique.
Reported By:
Nikhil Waingankar, MD, at the 31st Annual EAU Congress - March 12 - 15, 2016 – Munich, Germany
Fox Chase Cancer Center