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. 2009 Mar;181(3):993-7.
doi: 10.1016/j.juro.2008.11.017. Epub 2009 Jan 16.

Contemporary use of partial nephrectomy at a tertiary care center in the United States

R Houston Thompson  1 , Matt Kaag, Andrew Vickers, Shilajit Kundu, Melanie Bernstein, William Lowrance, David Galvin, Guido Dalbagni, Karim Touijer, Paul Russo
Affiliations

Contemporary use of partial nephrectomy at a tertiary care center in the United States

R Houston Thompson et al. J Urol. 2009 Mar.

Abstract

Purpose: The use of partial nephrectomy for renal cortical tumors appears unacceptably low in the United States according to population based data. We examined the use of partial nephrectomy at our tertiary care facility in the contemporary era.

Materials and methods: Using our prospectively maintained nephrectomy database we identified 1,533 patients who were treated for a sporadic and localized renal cortical tumor between 2000 and 2007. Patients with bilateral disease or solitary kidneys were excluded from study and elective operation required an estimated glomerular filtration rate of 45 ml per minute per 1.73 m(2) or greater. Predictors of partial nephrectomy were evaluated using logistic regression models.

Results: Overall 854 (56%) and 679 patients (44%) were treated with partial and radical nephrectomy, respectively. In the 820 patients treated electively for a tumor 4 cm or less the frequency of partial nephrectomy steadily increased from 69% in 2000 to 89% in 2007. In the 365 patients treated electively for a 4 to 7 cm tumor the frequency of partial nephrectomy also steadily increased from 20% in 2000 to 60% in 2007. On multivariate analysis male gender (p = 0.025), later surgery year (p <0.001), younger patient age (p = 0.005), smaller tumor (p <0.001) and open surgery (p <0.001) were significant predictors of partial nephrectomy. American Society of Anesthesiologists score, race and body mass index were not significantly associated with treatment type.

Conclusions: The use of partial nephrectomy is increasing and it is now performed in approximately 90% of patients with T1a tumors at our institution. For reasons that remain unclear certain groups of patients are less likely to be treated with partial nephrectomy.

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Figures

Figure 1
Figure 1
Partial nephrectomy use by year for subset of patients with tumors ≤4cm and treated in an elective situation
Figure 2
Figure 2
Partial nephrectomy use by year for subset of patients with tumors >4 – 7cm and treated in an elective situation
See this image and copyright information in PMC

References

    1. Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol. 2006;7:735. - PMC - PubMed
    1. Thompson RH, Leibovich BC, Lohse CM, Zincke H, Blute ML. Complications of contemporary open nephron sparing surgery: a single institution experience. J Urol. 2005;174:855. - PubMed
    1. Patard JJ, Shvarts O, Lam JS, Pantuck AJ, Kim HL, Ficarra V, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004;171:2181. - PubMed
    1. Becker F, Siemer S, Humke U, Hack M, Ziegler M, Stockle M. Elective nephron sparing surgery should become standard treatment for small unilateral renal cell carcinoma: Long-term survival data of 216 patients. Eur Urol. 2006;49:308. - PubMed
    1. Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H. Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc. 2000;75:1236. - PubMed

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