Vol. 179, No. 4, Supplement, Monday, May 19, 2008 THE JOURNAL OF UROLOGY® 379

resulting in permanent dialysis and 1 returned to theatre for secondary haemorrhage with conservation of the kidney. Median follow up was 35 months. 13 patients had temporary haemodialysis and 3 progressed to permanent dialysis. 3 patients have developed distal metastasis and 1 patient developed nodal disease. 1 patient died of metastasis. No local recurrence occurred.

CONCLUSIONS: The peri-operative morbidity of nephron sparing surgery is higher in patients with a single kidney than is reported for patients undergoing elective PN. The case mix of patients needs to be considered when reviewing the literature on outcome from PN. Earlynephrological and oncological results of PN in this group of patients are excellent.

Source of Funding: None

1101RESECTION OF RENAL CELL CARCINOMA (RCC) WITH EXTENDED VENA CAVA INVOLVEMENT WITH CARDIOPULMONARY BY PASS, HYPOTHERMIA AND CARDIAC ARREST USING EITHER STANDARD TECHNIQUE OR HEARTPORT® PORT-ACCESS™ SYSTEMSPierpaolo Graziotti*, Alessandro Piccinelli, Guido Giusti, Gianluigi Taverna, Orazio Maugeri, Marcello Bergonzini, Roberto Gallotti, Angelo Bandera. Rozzano, Italy.

INTRODUCTION AND OBJECTIVE: Herein we present our experience of surgical resection of RCC with level IV vena cava involvement with cardiopulmonary by pass, hypothermia and cardiac arrest by using either standard technique or a novel technique with Heartport® Port-Access™ System (Heartport).

METHODS: Since 1997, 12 patients (pts) affected with RCCwith level IV vena cava involvement were treated at our department. All pts underwent complete preoperative staging to exclude gross nodal involvement or distant metastases. In 6 pts, since MRI and/or

and/or atrial lumen, suitable for shape and dimensions to retrograde extraction from an inferior vena cava incision, Heartport® System was employed. This technique parallels what heart surgeons usually do during mitral valve replacement or coronary aortic by pass and allows for both nephrectomy and thrombus removal from a solely abdominal access. One of these procedures was converted in median sternotomy with atriotomy in order to remove a thrombus fragment that continuous transoesophageal ultrasound immediately showed to be left behind into the atrium. In 6 pts standard technique through median sternotomy and Chevron incision was carried out.

RESULTS: see table 2. Two pts with progressive disease are alive after a mean follow-up of 44 mos (36-52) and 3 are alive free of disease after a mean of 17 mos (8-31). 4 pts died for metastatic disease after a mean time of 14.2 mos (6-18).

CONCLUSIONS: Surgery of RCC with extended vena cava involvement is a demanding procedure that should be performed only at referral centers. In highly selected pts the use of Heartport® System

invasiveness of this operation.

table 1: demographicsStandard Operation Operation with Heartport

Number of pts 7 5Male/female 6/1 2/3Mean Age (years) 62,6 (54-71) 69,6 (37-79)

table 2: results (all these 3 pts were over 70 years)StandardOperation

Operation with Heartport

Operative time (min) 341 (240-420) 270 (240-300)Intensive care unit stay (days) 3.7 2.1Hospital stay (days) 9.8 7.1Postoperative death due to intestinal infarction 2/7 (28.5%) 1/5 (20%)Temporary acute renal failure 3 1Pneumothorax 1 0

Source of Funding: None

1102RELATIONSHIP OF TUMOR SIZE AND GRADE IN LOCALIZED RENAL CELL CARCINOMA: A SEER ANALYSISJason R Rothman*, Yu-Ning Wong, Brian L Egleston, Kevan Iffrig, Steve Lebovitch, Robert G Uzzo. Philadelphia, PA.

INTRODUCTION AND OBJECTIVE: Nuclear grade is a

METHODS: Data from Surveillance, Epidemiology and EndResults (SEER) were used to create a cohort of patients diagnosed with

if they were < 30 yrs old, had tumors >20 cm, had unknown nuclear grade, or had histologies other than clear cell, papillary, chromophobe, or adenocarcinoma. Nuclear grade 1 or 2 were considered “low” grade, while grade 3 or “anaplastic” tumors were “high” grade. We used a multinominal logistic model to predict the probability of increasing nuclear

were evaluated. 11,479 (61%) were male. The median age at diagnosis

nuclear grade distribution was 80.6% and 19.3% for low and high grade < 4 cm, 79%

tumors >7 cm were low grade (Table 1). Curves created through a multinominal logistic model reveal that the probability of nuclear grade 1 and 2 tumors decline as tumors become larger while the probability of

of high grade disease increase by 13% (OR=1.13, p<0.001).

are low grade tumors. Although the probability of a high grade tumor <

>7 cm exhibit low nuclear grade. These data have important implications

Low Grade (%) High Grade (%) Totals< 4 cm 7729 (86) 1250 (14) 89794-7 cm 5015 (79) 1361 (21) 6376> 7 cm 2439 (70) 1024 (30) 3463Totals 15,183 (81) 3635 (19) 18,818

Source of Funding: None