ABSTRACT
OBJECTIVE: To compare the trends of partial nephrectomy (PN) and radical nephrectomy (RN) in 2 European tertiary referral centers with regards to guideline changes. MATERIALS AND METHODS: A total of 1,573 patients who underwent RN or PN for localized (≤T2) renal cell carcinoma (RCC) were included. Logistic regression analyses assessed the predictors of PN and laparoscopy over time. RESULTS: Out of the total, 1,013 patients (65.6%) were treated with RN and 560 patients (34.4%) with PN. Also, 1,233 patients (80%) had open surgery whereas 340 patients (22%) were treated with a laparoscopic approach. Laparoscopic RN and PN were performed in 216 (13.7%) and 124 (7.8%) patients, respectively. T1b tumors were 73% less likely (p < 0.001) to be treated with PN compared to T1a tumors. The odds of undergoing PN or laparoscopy in 2008-2010 relative to 2000-2001 were 6.5-fold (p < 0.001) and 36-fold higher (p < 0.001), respectively. CONCLUSIONS: Tumor size and year of surgery are independent predictors of PN in our cohort. Our data exemplify the adoption of PN for RCC in tertiary care centers in Austria and Germany in line with implemented guideline changes. The utilization of PN has increased over time regardless of surgical approach. Further studies need to address the use of robot-assisted surgery and care in community hospitals.
Subject(s)
Carcinoma, Renal Cell/surgery , Kidney Neoplasms/surgery , Nephrectomy/methods , Nephrons/surgery , Referral and Consultation , Adult , Aged , Aged, 80 and over , Austria , Cohort Studies , Databases, Factual , Female , Germany , Humans , Laparoscopy/methods , Male , Middle Aged , Nephrectomy/adverse effects , Practice Guidelines as Topic , Regression Analysis , Robotic Surgical Procedures/methodsABSTRACT
OBJECTIVES: Beyond oncological safety, consideration of 30-day complications according to Clavien-Dindo, as well as postoperative quality of life (QoL) after nephron-sparing surgery for clinical T1 renal masses, represents important factors for treatment decision counseling. The objective of this study was to compare the effect of laparoscopic versus open partial nephrectomy (LPN vs. OPN) on 30-day complications and long-term postoperative QoL for clinical T1 renal masses. METHODS: Retrospective, longitudinal analysis of 293 patients treated with either LPN versus OPN for T1 renal masses. The investigated endpoints were 30-day Clavien-Dindo complications and health-related QoL (EORTC QLQ-C30). Respectively, logistic and linear regression models analyzed the effect of surgical partial nephrectomy approach on endpoints. RESULTS: Overall complication rates were similar in patients undergoing OPN or LPN (16.1 vs. 14.6 %, p = 0.8). Significantly less major complications (2.4 vs. 10.4 %, p = 0.025) occurred after LPN. Despite a shorter convalescence period for LPN patients (p = 0.035), in uni- and multivariable analyses, surgical approach was not associated with 30-day complications nor long-term differences in QoL (all p > 0.05). CONCLUSIONS: Despite a faster recovery time after LPN, our findings suggest that LPN and OPN are equivalent with regard to 30-day Clavien-Dindo complication rates and long-term QoL.
