Contemporary Use of Partial Nephrectomy at a Tertiary Care Center in the United States Journal Article

Authors: Thompson, R. H.; Kaag, M.; Vickers, A.; Kundu, S.; Bernstein, M.; Lowrance, W.; Galvin, D.; Dalbagni, G.; Touijer, K.; Russo, P.
Article Title: Contemporary Use of Partial Nephrectomy at a Tertiary Care Center in the United States
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<sup>2</sup> 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 &lt;0.001), younger patient age (p = 0.005), smaller tumor (p &lt;0.001) and open surgery (p &lt;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. © 2009 American Urological Association.
Keywords: adult; controlled study; aged; middle aged; surgical technique; major clinical study; mortality; united states; prospective study; tumor localization; tumor volume; morbidity; surgical approach; data base; kidney carcinoma; kidney neoplasms; nephrectomy; patient identification; hospitals; body mass; kidney; partial nephrectomy; kidney tumor; carcinoma, renal cell; scoring system; carcinoma; predictor variable; glomerulus filtration rate; multivariate analysis; tertiary health care; logistic regression analysis; race difference; renal cell; anesthesist
Journal Title: Journal of Urology
Volume: 181
Issue: 3
ISSN: 0022-5347
Publisher: Elsevier Science, Inc.  
Date Published: 2009-03-01
Start Page: 993
End Page: 997
Language: English
DOI: 10.1016/j.juro.2008.11.017
PUBMED: 19150552
PROVIDER: scopus
PMCID: PMC2724261
Notes: --- - "Cited By (since 1996): 18" - "Export Date: 30 November 2010" - "CODEN: JOURA" - "Source: Scopus"
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MSK Authors
  1. Paul Russo
    457 Russo
  2. Guido Dalbagni
    253 Dalbagni
  3. Shilajit D Kundu
    9 Kundu
  4. Matthew G Kaag
    32 Kaag
  5. Abdelkrim Karim Touijer
    190 Touijer
  6. Andrew J Vickers
    565 Vickers
  7. David Jonathan Galvin
    11 Galvin