MP57-04 PREDICTORS OF SURGICAL APPROACH FOR TREATMENT OF RENAL CELL CARCINOMA

Abstract

You have accessJournal of UrologyKidney Cancer: Surgical Therapy II1 Apr 2015MP57-04 PREDICTORS OF SURGICAL APPROACH FOR TREATMENT OF RENAL CELL CARCINOMA Manish Patel, Stephen Strahan, Albert Bang, Justin Vass, and David Smith Manish PatelManish Patel More articles by this author , Stephen StrahanStephen Strahan More articles by this author , Albert BangAlbert Bang More articles by this author , Justin VassJustin Vass More articles by this author , and David SmithDavid Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1992AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Over the last 2 decades the adoption of partial nephrectomy (PN) and laparoscopy (Lap) has substantially changed the surgical management of renal cell carcinoma (RCC). This study explores the patterns of surgical approach for RCC and aims to identify predictors of surgical approach in an Australian, population based study. METHODS Using the New South Wales (NSW) central cancer registry we identified all cases of RCC diagnosed between 2001 and 2007 in the state. Records were linked to the to the NSW Admitted Patient Data Collection (APDC), to retrieve treatment details and to the Registry of Births Deaths and Marriages and Australian Bureau of Statistics to obtain death details. The cohort of 3840 individuals who underwent surgical management of their kidney mass were selected for this study. Multivariable logistic regression analysis was used to determine predicitors of PN and Lap. RESULTS In the entire cohort 14% received PN and 41% Lap. Of the cohort with localized disease only (n=2789) 15% received PN and 46% Lap. For individuals with localized disease, the percentage receiving PN compared to radical nephrectomy (RN) increased gradually from years 2001 to 2005 but then decreased after this. This coincided with a steady increase in Lap compared to Open from 2001 to 2004, followed by a sudden further increase after 2005. Multivariable analysis demonstrated that age (HR:0.99, [0.98-0.99]), year of surgery (HR:1.13, [1.08-1.20]), comorbidity (HR:1.45, [1.10-1.92]) and hospital case load >17/year (1.86,[1.20-2.88]) predicted use of PN. Year of surgery (HR:1.23,[1.18-1.28])), comorbidity (HR:0.62,[0.50-0.78]), non-teaching hospital ( HR:0.54,[0.40-0.74]), private hospital (HR:2.11,[1.60-2.79]) and hospital case load>8/year (HR:2.71,[1.98-3.71])predicted use of Lap. CONCLUSIONS The decrease in PN use at a time when laparoscopic RN was becoming more widely adopted suggests that Lap RN may be used in preference to open PN. Age, year of surgery, co-morbidity and hospital caseload predict the likelihood of using PN. Year of surgery, teaching hospital status, private hospital status and annual caseload predicted the likelihood of using Laparoscopy. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e690-e691 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Manish Patel More articles by this author Stephen Strahan More articles by this author Albert Bang More articles by this author Justin Vass More articles by this author David Smith More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...