Abstract
ObjectiveTo describe the temporal trends in nephrectomy practice and outcomes for English patients with renal cell carcinoma (RCC).Patients and MethodsAdult RCC nephrectomy patients treated between 2000 and 2010 were identified in the National Cancer Data Repository and Hospital Episode Statistics, and followed‐up until date of death or 31 December 2015 (n = 30 763). We estimated the annual frequency for each nephrectomy type, the hospital and surgeon numbers and their case volumes. We analysed short‐term surgical outcomes, as well as 1‐ and 5‐year relative survivals.ResultsAnnual RCC nephrectomy number increased by 66% during the study period. Hospital number decreased by 24%, whilst the median annual hospital volume increased from 10 to 23 (P < 0.01). Surgeon number increased by 27% (P < 0.01), doubling the median consultant number per hospital. The proportion of minimally invasive surgery (MIS) nephrectomies rose from 1% to 46%, whilst the proportion of nephron‐sparing surgeries (NSS) increased from 5% to 16%, with 29% of all T1 disease treated with partial nephrectomy in 2010 (P < 0.01). The 30‐day mortality rate halved from 2.4% to 1.1% and 90‐day mortality decreased from 4.9% to 2.6% (P < 0.01). The 1‐year relative survival rate increased from 86.9% to 93.4%, whilst the 5‐year relative survival rate rose from 68.2% to 81.2% (P < 0.01). Improvements were most notable in patients aged ≥65 years and those with T3 and T4 disease.ConclusionsSurgical RCC management has changed considerably with nephrectomy centralisation and increased NSS and MIS. In parallel, we observed significant improvements in short‐ and long‐term survival particularly for elderly patients and those with locally advanced disease.
Highlights
Incidence of RCC has been increasing worldwide year-onyear by 3–4% and accounts for ~3% of all new cancer diagnoses in the UK [1,2]
We describe the changes to RCC nephrectomy activity and service provision in England in recent years and investigate temporal trends in short- and long-term outcomes with a particular focus on survival
The National Cancer Data Repository (NCDR) contains tumour level records submitted by the eight English Cancer Registries, together with survival information sourced from the Office for National Statistics (ONS) [11]
Summary
Incidence of RCC has been increasing worldwide year-onyear by 3–4% and accounts for ~3% of all new cancer diagnoses in the UK [1,2]. RCC survival in England has lagged behind many other European countries [3,4]. Initiatives to improve outcomes through surgical service centralisation, reducing diagnostic delay, and increasing multidisciplinary team involvements in patient care were introduced in the Improving outcomes in urological cancer Guidance in 2002 [5]. There is a growing move towards the use of nephron-sparing surgery (NSS) and laparoscopic or robotic nephrectomy [6,7]. Many population-based studies examining RCC survival have focused on patients irrespective of treatment modality and may include those who received no active treatment [8,9,10]
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