Adherence to guideline recommendations for management of clinical T1 renal cancers in the Netherlands: a population-based study

Abstract

with PN in cT1a and laparoscopic RN in cT1b were evaluated with logistic regression analyses. Results An increase in nephron-sparing treatment strategies (NSS) of cT1a patients (N total = 2436) was observed; in 2014, 67 % underwent NSS (62 % PN and 5 % thermal ablation). Age, a non-central tumor localization and being treated in a high-volume hospital were associated with PN. Although NSS were applied more frequently over time, the majority (70 %) of cT1b patients (N total = 2205) underwent RN in 2014, mainly performed laparoscopically. Increasing tumor size, tumor localization in the right kidney and being treated in a university hospital were associated with a lower probability of a laparoscopic RN versus open. Treatment in a high-volume hospital was associated with a higher probability of laparoscopic RN. Conclusions Dutch patients with cT1 renal cancer are predominantly treated according to current guidelines. Data of this pre-specified quality indicator analysis of a urological national guideline may serve as a model for international comparison of treatment of cT1 renal cancers.

Trends in the surgical management of stage 1 renal cell carcinoma: findings from a population‐based study

“…We found that the proportion of patients with T1a tumours treated by NSS increased by 77% between 2009 and 2013, and that 62% of T1a tumours were treated by this surgical procedure in 2013. With this change, surgical management of T1a tumours in the Australian state of Victoria is now similar to practice patterns found in the Netherlands [15], Sweden [22] and the UK [23].…”

“…While others have suggested that greater use of laparoscopic surgical procedures may be hindering the uptake of NSS for T1b tumours , our results suggest that this may not be the case in Australia. Our rates of NSS for T1b tumours in 2013 were similar to levels found in the USA in 2009 (18%), but lower than levels seen in the Netherlands (28%) in 2013 . The present study suggests that, in Australia, T1b tumours are still largely treated by radical nephrectomy.…”

“…Research from the USA, however, has suggested this is not the case, with several population-based studies showing that use of NSS for small tumours increased substantially during the 2000s [11][12][13] with, for instance, one study reporting that use of NSS for T1a tumours increased from 5% in 1988 to 40% in 2008 [11], while another reported use increased from 43% in 2004 to 55% in 2009 [14], the year the AUA published their treatment guidelines recommending this NSS for cT1a tumours. Similarly, population-based studies from Europe have suggested that 50% or more of patients with small renal tumours were treated by NSS in 2010, with for instance, a population-based study from the Netherlands finding that 49% of cT1a tumours were treated by NSS in 2010 [15], while a study of treatment of T1a tumours in 56 centres in France found that 77% were treated by NSS in 2010 [16].…”

Surgical treatment of kidney tumors – contemporary trends in clinical practice

“…Indications for surgery strictly follow the European Association of Urology (EAU) guidelines for treatment of renal tumors [2]. Resection is preferred before nephrectomy in all T1 category (≤7 cm) cases [9, 10, 11]. In resection, as well as in nephrectomy, preference is given to the less invasive approach (laparoscopic, even robotically assisted) before open surgery [12].…”

Renal cell carcinoma

“…Aben et al [1] have focused on adherence to guideline recommendation for management of clinical T1 renal cancers in the Netherlands. In this populationbased study, the implications of national and international guidelines are well evaluated and provide insight on how adherence to guidelines could be compared across different health care systems in Europe.…”