Does laparoscopy beget underuse of partial nephrectomy for T1renal masses? Competing treatment decision pathways may influence utilization

Background and Purpose: It has been suggested that renal laparoscopy has resulted in an underuse of partial nephrectomy (PN) for small renal masses in the U.S. In the absence of evidence-based medicine (EBM) guide-lines, multiple-perspective reasoning is required where complete v partial nephrectomy and the laparoscopic v the open surgical approach must be considered. We report on the PN rate in a contemporary laparoscopic-era series of patients with T1 renal masses and examine the potential influence of the management decision tree on the PN rate. Patients and Methods: An actively managed database of referred patients with T1 renal masses was utilized retrospectively. All patients were evaluated by a single fellowship-trained urologic oncologist with formal laparoscopic training. Patients were presented with a management decision tree in which PN v total nephrectomy (TN) was the first decision node, laparoscopy v open surgery was the second decision node, and the actual PN rate was reported. We then cons...