Urologic Oncology: Seminars and Original Investigations
Original articleTrends in renal cancer surgery and patient provider characteristics associated with partial nephrectomy in the United States
Introduction
In 2005, an estimated 36,160 incident cases of kidney cancer occurred in the United States, with an estimated 12,660 deaths [1]. The majority of newly diagnosed tumors will be localized to the kidney, and the incidence of these organ-confined renal cancers is increasing [2]. The current standard of care for clinically organ-confined renal cancer is nephrectomy, with patients having more than 90% 5-year overall survival rates for pathologically organ-confined disease.
Either total or partial nephrectomy is performed to primarily treat organ-confined renal tumors. Although there are specific relative indications for each of these procedures, many patients are candidates for either procedure. Partial nephrectomy offers maximal preservation of normal renal tissue, however, it is more technically demanding and is associated with increased risk of perioperative secondary procedures [3]. Therefore, it is still considered acceptable practice to remove an entire kidney for a renal mass if the contralateral kidney is normal. Despite this, similar cancer control rates [4] and safety profiles [5] have led some urologic surgeons to advocate partial nephrectomy as the “gold standard” for treating small renal tumors [6].
There are limited data on the number of partial and total nephrectomies performed in the United States, and, to our knowledge, no studies have examined if clinical or demographic factors are associated with undergoing either total or partial nephrectomy. The goals of this study were to determine the frequency of total and partial nephrectomy, and examine patient, provider, and demographic characteristics associated with these procedures.
Section snippets
Data source
Discharge data from the National Inpatient Sample for the years 1998–2002 were analyzed. The National Inpatient Sample is a multilevel probability sample of hospital discharges in the United States, and is maintained by the Healthcare Cost and Utilization Project [7]. It contains discharge level administrative data from 995 hospitals, representing approximately 20% of the hospitals in the United States. The sampling design of the National Inpatient Sample allows valid assessments of health care
Results
The selection process resulted in a study population representing 117,078 patient discharges. A total of 103,315 patients underwent total nephrectomy, and 13,763 underwent partial nephrectomy. Demographic characteristics are given in Table 1.
Between 1998 and 2002, the total number of nephrectomies performed in the United States increased yearly (Fig. 1). Over the same period, the ratio of partial to total nephrectomies also increased (trend test P < 0.001; Fig. 2).
Women were less likely to
Discussion
There have been few previous studies examining trends in renal surgery for neoplasm. In 2001, Rosin et al. [9] published a single institution series of 309 patients who underwent nephrectomy between 1970 and 1996. Of 123 patients with neoplasm, they found that the partial nephrectomy rate increased from 24% in the 1970s to 73% between 1986 and 1996. In 1997, Marshall et al. [10] published the results of an analysis using the National Cancer Database. Of all patients treated surgically for renal
Acknowledgments
This article represents research completed in part while Dr. Porter was a Veterans Administration fellow in the Robert Wood Johnson Clinical Scholars Program. The opinions in this article are those of the authors and do not necessarily represent those of the Robert Wood Johnson Foundation or the Veterans Administration.
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