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Partial nephrectomy for small renal masses: an emerging quality of care concern?
David C Miller1, John M Hollingsworth, Khaled S Hafez
1Michigan Urology Center, University of Michigan Medical Center, USA.
Purpose:
The recent popularization of laparoscopic radical nephrectomy may beget underuse of partial nephrectomy. To evaluate this concern we used the SEER registry to characterize national practice patterns for the surgical management of small renal masses.
Materials And Methods:
Between 1988 and 2001, 14,647 patients with primary tumor size 7 cm or less were treated surgically for locoregional kidney cancer. The proportion of patients treated with PN was determined and stratified by year of diagnosis and tumor size. Multivariate models were developed to identify independent determinants of PN use and overall survival following surgical treatment of kidney cancer.
Results:
Overall 1,401 patients (9.6%) were treated with PN vs 13,246 (90.4%) who underwent total nephrectomy. For tumors 7 cm or less, the use of PN increased progressively between 1988 (4.6%) and 2001 (17.6%, p < 0.001). Despite this trend PN remained fairly uncommon even for the smallest renal masses. Among patients with tumors less than 2 cm, 14% underwent PN in 1988 to 1989 vs 42% in 2000 to 2001. For tumors 2 to 4 cm the corresponding proportions were 5% and 20%, respectively (p < 0.001). Younger patient age, smaller tumor size and more recent diagnostic year were independent determinants of PN use (all p values < 0.05). All cause mortality was similar for patients treated with PN vs TN (HR 0.9, 95% CI 0.8-1.1).
Conclusions:
Despite more frequent application during the last 2 decades, nationwide use of PN remains relatively uncommon, even for the smallest renal masses. Recognizing the favorable outcomes associated with preservation of renal parenchyma, our findings identify a possible quality of care concern that should be addressed by the urological community.
Insights
Partial nephrectomy (PN) for small renal masses increased but remains uncommon. This suggests a potential quality of care issue for kidney cancer treatment, despite similar survival rates to total nephrectomy (TN).
Area of Science:
- Urology
- Surgical Oncology
- Nephrology
Background:
- Laparoscopic radical nephrectomy's popularity may lead to reduced use of partial nephrectomy (PN).
- Understanding national practice patterns for surgical management of small renal masses is crucial.
Purpose of the Study:
- To characterize national practice patterns for surgical management of small renal masses.
- To evaluate the concern of potential underuse of partial nephrectomy (PN) in favor of radical nephrectomy.
Main Methods:
- Analysis of 14,647 patients with kidney tumors ≤7 cm from the SEER registry (1988-2001).
- Determination of PN proportion stratified by diagnosis year and tumor size.
- Development of multivariate models to identify determinants of PN use and survival.
Main Results:
- PN use increased from 4.6% (1988) to 17.6% (2001) for tumors ≤7 cm.
- For tumors <2 cm, PN use rose from 14% to 42%; for 2-4 cm tumors, it rose from 5% to 20%.
- Younger age, smaller tumor size, and recent diagnosis year independently predicted PN use; survival was similar for PN and total nephrectomy (TN).
Conclusions:
- Partial nephrectomy (PN) remains underutilized for small renal masses despite increased application.
- This underuse may represent a quality of care concern within the urological community.
- Favorable outcomes associated with renal parenchyma preservation warrant further investigation and potential intervention.
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