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. 2018 Oct;122(4):599-609.
doi: 10.1111/bju.14217. Epub 2018 Apr 20.

Time trends in service provision and survival outcomes for patients with renal cancer treated by nephrectomy in England 2000-2010

Ray C J Hsu  1   2 , Matthew Barclay  3 , Molly A Loughran  4   5 , Georgios Lyratzopoulos  3   6 , Vincent J Gnanapragasam  1   2 , James N Armitage  2
Affiliations

Time trends in service provision and survival outcomes for patients with renal cancer treated by nephrectomy in England 2000-2010

Ray C J Hsu et al. BJU Int. 2018 Oct.

Abstract

Objective: To describe the temporal trends in nephrectomy practice and outcomes for English patients with renal cell carcinoma (RCC).

Patients and methods: Adult RCC nephrectomy patients treated between 2000 and 2010 were identified in the National Cancer Data Repository and Hospital Episode Statistics, and followed-up until date of death or 31 December 2015 (n = 30 763). We estimated the annual frequency for each nephrectomy type, the hospital and surgeon numbers and their case volumes. We analysed short-term surgical outcomes, as well as 1- and 5-year relative survivals.

Results: Annual RCC nephrectomy number increased by 66% during the study period. Hospital number decreased by 24%, whilst the median annual hospital volume increased from 10 to 23 (P < 0.01). Surgeon number increased by 27% (P < 0.01), doubling the median consultant number per hospital. The proportion of minimally invasive surgery (MIS) nephrectomies rose from 1% to 46%, whilst the proportion of nephron-sparing surgeries (NSS) increased from 5% to 16%, with 29% of all T1 disease treated with partial nephrectomy in 2010 (P < 0.01). The 30-day mortality rate halved from 2.4% to 1.1% and 90-day mortality decreased from 4.9% to 2.6% (P < 0.01). The 1-year relative survival rate increased from 86.9% to 93.4%, whilst the 5-year relative survival rate rose from 68.2% to 81.2% (P < 0.01). Improvements were most notable in patients aged ≥65 years and those with T3 and T4 disease.

Conclusions: Surgical RCC management has changed considerably with nephrectomy centralisation and increased NSS and MIS. In parallel, we observed significant improvements in short- and long-term survival particularly for elderly patients and those with locally advanced disease.

Keywords: #KidneyCancer; centralisation; nephrectomy; postoperative outcomes; renal cancer; survival.

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Figures

Figure 1
Figure 1
A. Total number of RCC nephrectomies performed in England and B. post‐nephrectomy deaths in each calendar year.
Figure 2
Figure 2
The 30‐day, 90‐day, 1‐year and 5‐year age‐adjusted relative survival rates in patients with RCC treated with nephrectomy between 2000 and 2010.
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