Assessing Performance Trends in Laparoscopic Nephrectomy and Nephron-sparing Surgery for Localized Renal Tumors

Marc C. Smaldone, Alexander Kutikov, Brian Egleston, Jay Simhan, Daniel J. Canter, Ervin Teper, Rosalia Viterbo, David Y.T. Chen, Richard E. Greenberg, Robert G. Uzzo
2012 Urology  
Objective-To assess the impact of laparoscopy on utilization of partial nephrectomy (PN) by comparing national utilization trends in patients undergoing surgery for localized renal tumors. Methods-Using linked Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we retrospectively examined trends in procedure utilization from 1995-2007 for patients undergoing surgery for localized (stage I/II) renal masses. Procedures were classified as open radical nephrectomy (ORN), laparoscopic
more » ... adical nephrectomy (LRN), open partial nephrectomy (OPN), and laparoscopic partial nephrectomy (LPN). Patients were further stratified by tumor size (≤4cm, >4 to ≤7cm, >7cm). Data were primarily analyzed using logistic regressions. Results-11,689 patients (mean age 74.4±5.7 years, 56% male) with a mean tumor size of 4.7±3.3cm met inclusion criteria. From 1995-2007, ORN rates decreased while for each year successive year, patients were more likely to be treated with OPN (OR 1.17, CI 1.14-1.19), LRN (OR 1.44, CI 1.41-1.47) and LPN (OR 1.75, CI 1.68-1.83). While the increased utilization of OPN (7.5% vs. 13.6%, p<0.001) and LPN (0% vs. 14.2%, p<0.001) reached statistical significance, this was offset by a marked increase in LRN over the same time period (3.0% vs. 43.0%, p<0.001). Conclusions-Despite increasing emphasis on nephron preservation, PN utilization rates remain low. Compared to a 40% increase in LRN, utilization of PN increased by only 20% from 1995-2007. As a result, 72% of identified Medicare beneficiaries with localized tumors were managed with RN in 2007. The trade-off of minimally invasive surgery for nephron preservation may have adverse long term consequences.
doi:10.1016/j.urology.2012.02.067 pmid:22704174 pmcid:PMC3411888 fatcat:vgscpg42u5hvzhsk5xdcerwtsu