Surgical management of pediatric renal masses: surgeon subspecialty practice patterns

Management of pediatric renal masses has lagged behind adult paradigms adopting minimally invasive surgery (MIS) and nephron-sparing surgery (NSS). This study investigated national practice patterns between pediatric urologists (PU) and pediatric surgeons (PS) in pediatric renal malignancy.

The Pediatric National Surgical Quality Improvement Program database was queried for CPT codes for radical/partial nephrectomy from 2012-2017 performed for renal malignancy. Patients were grouped by specialty and operative approach.

PU managed 175 (17%) patients while PS managed 811 (77%). PU were more likely to use MIS (14% versus 5%, p < 0.001) and NSS (33% versus 13%, p < 0.001) compared to PS. PS more commonly performed lymph node (LN) sampling/tumor thrombectomy, especially in MIS cases (67% versus 35%, p = 0.008). PS operated on younger patients with higher ASA class compared to PU, but had higher transfusion rates and longer length of stay. Central venous access surgery was more commonly performed on patients operated on by PS, while PU performed more cystoscopy/retrograde pyelography. Patients who underwent NSS compared to radical nephrectomy were less likely to undergo LN sampling, while LN sampling did not differ between open and MIS groups.

PU were likely to perform MIS and NSS than PS for pediatric renal masses in this national database. This likely results from inherent training differences between PS and PU and reflects emerging data on safety and efficacy of these advanced surgical techniques. Further investigation into the impact on oncologic and clinical outcomes by surgical specialty and operative approach is necessary.