Conclusions: Obesity appears to repre-sent an adverse prognosticator with re-spect to operative blood loss. However, itdoes not appear to predict disease spe-cific outcomes or intra-operative out-comes.

UP-01.206Prognosis and Characteristics of RenalCell Carcinoma in HemodyalisisPatients: Comparison BetweenUnilateral and Bilateral OccurrenceTakagi T1, Kondo T1, Izuka J1,Kobayashi H1, Hashimoto Y1, Ito F1,Nakazawa H2, Tanabe K1

1Dept. of Urology, Tokyo Women’sMedical University; 2Medical Center East,Tokyo, Japan

Introduction and Objective: Patientswith end-stage renal disease (ESRD) re-quiring hemodyalisis (HD) have a higherincidence of renal cell carcinoma (RCC)compared to the general population. Pa-tients with bilateral sporadic RCC have apoor prognosis compared to those withunilateral RCC. Moreover, bilateral meta-chronous occurrence of sporadic RCCwas associated with an unfavorable prog-nosis compared with bilateral synchro-nous occurrence. In the previous report,cancer specific prognostic factors for HDpatients with RCC have not been dis-cussed. In the present study, we analyzedthe prognosis and characteristics of RCCin HD patients after radical nephrectomyand compared those with unilateral andbilateral occurrence.Materials and Methods: Two-hundredand forty six HD patients who underwentradical nephrectomy for RCC were thesubjects of the present study. Of these,unilateral RCC occurred in 201 patients,bilateral synchronous in 15 and bilateralmetachronous in 30. Cancer specific sur-vival was accessed by Kaplan-Meiermethod.Results: Cancer specific survival was notsignificantly different between twogroups. (5-year: unilateral, 90%; bilateral,90%; P�0.9509). Seventeen patients of201 (8.5%) with unilateral occurrence and4 patients of 45 (8.9%) with bilateral oc-currence died from kidney cancer in thefollow up periods. The presence of ACDK(unilateral, 73%; bilateral 91%;P�0.00319) and mean duration of hemo-dialysis before surgery (unilateral:157�91months, bilateral: 189�83.5,P�0.0319) are significantly different be-tween the two groups. Bilateral occur-rence had more multifocal tumors thanwith unilateral occurrence (bilateral: 74%,

unilateral: 30%, P�0.0001). Pathologicalfindings (unilateral: clear cell 84%, papil-lary cell 14%, bilateral: clear cell 76%, pap-illary 22%), tumor grade, tumor size andpathological stage were not significantlydifferent between the two groups. Longerduration of HD before surgery(P�0.0091), tumor size (P�0.0112) andtumor grade (P�0.0062) were unfavorableprognostic factors for death from RCC asshown by multivariate analysis.Conclusion: The type of occurrence ofRCC, unilateral or bilateral, in HD patientsdid not appear to have influenced the can-cer specific survival. Patients with longduration of HD have to be followedstrictly, because they tend to have bilat-eral kidney cancer and poor cancer prog-nosis.

UP-01.207Thermal Damage of the SoftCoagulation in Pig’s KidneyOta T, Ochi A, Enatsu N, Ikeda A,Funada S, Rii J, Suzuki K, Shiga N,Komatsu HDept. of Urology, Kameda MedicalCenter, Japan

Introduction and Objective: A suture ofthe kidney after a tumor resection in par-tial nephrectomy sometimes inducesbleeding by the surgical needle, and aninjury of the arcuate or interlobbar arterycauses of pseudo-aneurism or arterio-ve-nous fistura. Furthermore, the ligation ofnormal kidney tissues makes ischemicdamage. It is well-known the soft coagula-tion is useful and safety for stopping ofhemorrhage and leakage in lung, liver andpancreas surgery. Major complications ofpartial nephrectomy are also hemorrhageand leakage of urine. Then, we appliedthe soft coagulation on partial nephrec-tomy to avoid sutures, and reported thisnovel method was safety and useful. Onthe other hand a high temperature by anelectrosurgical knife may damage normalkidney tissues. Here, we investigated thethermal effect of the soft coagulation us-ing a pig’s kidney.Material and Methods: Using a pig’skidney, the maximum temperature of sur-face and section were measured by a ther-mography on condition of the soft coagu-lation effect 7 (SC7), effect 3 (SC3),forced coagulation (FC) and spray coagula-tion (Sp). The maximum temperature at5mm and 7mm deep were measured by athermometer on condition of SC7 andSC3.Results: The maximum surface tempera-ture on SC7, SC3, FC and Sp were 88.3°,

99.2°, 176.1° and over 250°, respectively.The maximum section temperature onSC7, SC3, FC and Sp were 110.6°, 144.1°,158.6° and over 250°, respectively. Themaximum temperature at 5mm and 7mmdeep were 58°, 31.5° on SC7 and 85°, 62°on SC3, respectively.Conclusions: The maximum temperatureon SC7 or SC3 is lower than on FC or Sp.The thermal damage of kidney tissues iswithin 5mm or less on SC7. The thermaldamage of normal kidney tissues using thesoft coagulation is limited, and this haspossibility to protect the residual renalfunction.

UP-01.208Survival Following Nephrectomy forAdvanced Renal Cell Tumors WithRenal Vein InvolvementYamamoto H1, Nemade H1,Makanjuola J1, Lloyd G1, Chowdhury S2,Kooiman G1

1Dept. of Urology; 2Dept. of Oncology,King’s College Hospital, London, UK

Introduction and Objective: Advancedrenal cell cancer (RCC) with renal veininvolvement is associated with a poorprognosis.However, a multimodal ap-proach consisting of cytoreductive ne-phrectomy, systemic therapy and metasta-sectomy have been useful in prolongingthe overall and progression free survival.The objective is to determine the oncolog-ical outcome in our case series of patientswho underwent radical nephrectomy forstage T3 and T4 renal carcinoma.Materials and Methods: Twenty-fourconsecutive patients underwent radicalnephrectomy (n�18) or cytoreductivenephrectomy (n�6), with or without sys-temic therapy.Results: Mean age of the cohort was65�10yrs (M:F 5:1). Seventeen and 6 pa-tients underwent open and laparoscopicnephrectomy, respectively.Mean follow-uptime was 27�22months. The tumor wasinoperable in one patient.The proportionof disease stages were: T3a (46%), T3b(46%), T3c and T4 (8%).In 6 patients, thedisease was already metastatic.Five pa-tients received adjuvant systemic therapy(sunitinib or interferon) at 59�21daysfollowing surgery.Second line (n�4), thirdline (n�2), and fourth line (n�1) sys-temic therapy was administered in somepatients.Four patients have died from dis-ease progression.Kaplan-Meier analysisrevealed overall survival to be 86% at 24months.Conclusions: A multimodal approachconsisting of radical surgery and systemic

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UROLOGY 78 (Supplement 3A), September 2011 S257