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

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

*Corresponding author for this work

Research output: Contribution to journalArticle

124 Citations (Scopus)

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 m2 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.

Original languageEnglish (US)
Pages (from-to)993-997
Number of pages5
JournalJournal of Urology
Volume181
Issue number3
DOIs
StatePublished - Mar 1 2009

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Nephrectomy
Tertiary Care Centers
Neoplasms
Kidney
Logistic Models
Tertiary Healthcare
Glomerular Filtration Rate
Body Mass Index
Multivariate Analysis
Databases

Keywords

  • carcinoma
  • kidney
  • kidney neoplasms
  • mortality
  • nephrectomy
  • renal cell

ASJC Scopus subject areas

  • Urology

Cite this

Thompson, R. H., Kaag, M., Vickers, A., Kundu, S., Bernstein, M., Lowrance, W., ... Russo, P. (2009). Contemporary Use of Partial Nephrectomy at a Tertiary Care Center in the United States. Journal of Urology, 181(3), 993-997. https://doi.org/10.1016/j.juro.2008.11.017
Thompson, R. Houston ; Kaag, Matt ; Vickers, Andrew ; Kundu, Shilajit ; Bernstein, Melanie ; Lowrance, William ; Galvin, David ; Dalbagni, Guido ; Touijer, Karim ; Russo, Paul. / Contemporary Use of Partial Nephrectomy at a Tertiary Care Center in the United States. In: Journal of Urology. 2009 ; Vol. 181, No. 3. pp. 993-997.
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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 m2 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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Thompson, RH, Kaag, M, Vickers, A, Kundu, S, Bernstein, M, Lowrance, W, Galvin, D, Dalbagni, G, Touijer, K & Russo, P 2009, 'Contemporary Use of Partial Nephrectomy at a Tertiary Care Center in the United States', Journal of Urology, vol. 181, no. 3, pp. 993-997. https://doi.org/10.1016/j.juro.2008.11.017

Contemporary Use of Partial Nephrectomy at a Tertiary Care Center in the United States. / Thompson, R. Houston; Kaag, Matt; Vickers, Andrew; Kundu, Shilajit; Bernstein, Melanie; Lowrance, William; Galvin, David; Dalbagni, Guido; Touijer, Karim; Russo, Paul.

In: Journal of Urology, Vol. 181, No. 3, 01.03.2009, p. 993-997.

Research output: Contribution to journalArticle

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T1 - Contemporary Use of Partial Nephrectomy at a Tertiary Care Center in the United States

AU - Thompson, R. Houston

AU - Kaag, Matt

AU - Vickers, Andrew

AU - Kundu, Shilajit

AU - Bernstein, Melanie

AU - Lowrance, William

AU - Galvin, David

AU - Dalbagni, Guido

AU - Touijer, Karim

AU - Russo, Paul

PY - 2009/3/1

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N2 - 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 m2 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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KW - carcinoma

KW - kidney

KW - kidney neoplasms

KW - mortality

KW - nephrectomy

KW - renal cell

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