Contemporary trends in nephrectomy for renal cell carcinoma in the United States: results from a population based cohort

Abstract

Purpose: Despite benefits in functional renal outcome and the similar oncological efficacy of partial nephrectomy for renal cell carcinoma, previous studies show marked underuse of partial nephrectomy. We describe national trends in partial and radical nephrectomy using a contemporary, population based cohort. Materials and Methods: Using the 2003 to 2008 Nationwide Inpatient Sample we identified 188,702 patients treated with partial or radical nephrectomy for renal cell carcinoma at a total of 1,755 hospitals. Multivariate logistic regression was used to assess the independent associations of patient and hospital characteristics with partial nephrectomy. Post-estimations from multivariate logistic regression were done to ascertain the annual predicted probability of partial nephrectomy by hospital feature. Results: Overall 149,636 (79.3%) and 39,066 patients (20.7%) underwent radical and partial nephrectomy for renal cell carcinoma, respectively. Partial nephrectomy use increased each year from 16.8% in 2003 to 25.1% in 2008 (p for trend <0.001). On multivariate analysis patients were more likely to undergo partial nephrectomy at teaching (OR 1.31, p < 0.001) and urban (OR 1.13, p = 0.05) hospitals compared to nonteaching and rural hospitals, respectively. Each quartile of higher nephrectomy annual volume was associated with higher odds of partial nephrectomy compared to the lowest quartile (OR 1.21, p < 0.001). Although annual predicted partial nephrectomy use increased across all hospitals, differences in annual partial nephrectomy use by teaching status, site (urban vs rural) and case volume persisted with time. Conclusions: Although the use of partial nephrectomy for renal cell carcinoma is increasing nationally across all hospitals, academic and urban hospitals as well as those with higher nephrectomy volume continue to show higher partial nephrectomy use for renal cell carcinoma. Editorial CommentSince development of laparoscopy in urology, we evolved from open nephrectomy to partial open nephrectomy to Laparoscopic radical Nephrectomy, then nephron-sparing laparoscopic partial nephrectomy

Rates of open versus laparoscopic and partial versus radical nephrectomy for T1a renal cell carcinoma: A population‐based evaluation

“…That being said, previous reports also suggest that several sociodemographic factors might affect the type of treatment . However, the current report, as well as previous analyses, was unable to justify a causal relationship between sociodemographic factors and treatment type.…”

“…Furthermore, hospital‐ and surgeon‐attributable factors might also strongly influence the type of treatment a patient might receive . Indeed, it has been shown that nephron‐sparing and/or laparoscopic procedures are significantly less likely to be carried out at hospitals with a teaching status and/or low hospital volume . This effect might have been operational within the current study when comparing the utilization rates of ORN and OPN according to SEER registries.…”

“…Furthermore, postoperative morbidity for PN has substantially decreased in recent years . Consequentially, at tertiary care centers, the majority of patients with localized RCC undergo a PN (>90%) . Despite several advantages related to PN, the adoption of PN has been less gradual and mostly concentrated among select hospitals according to existing population‐based series .…”

“…When technically feasible, RN is no longer an acceptable option when a PN is indicated, and might even be considered as malpractice . Despite its established benefits, PN use remains low (25% in 2008) in the community setting, and sharply contrasts with the rate of use at centers of excellence (90% in 2007) …”

Increased Tissue Factor Expression is an Independent Predictor of Mortality in Clear Cell Carcinoma of the Kidney

“…,00 1,00 ,00-censored 1,00-censored ,00 1,00 ,00-censored 1,00-censored and ours is no exception (23). Our perioperative mortality rate was 1.7% (1/58), similar to most recently published surgical series of radical and partial nephrectomies (around 0.9%) (24), and we have to consider that one of our patients who died preoperatively was an octogenarian.…”