Partial nephrectomy: Mayo clinic experience 1957–1977
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Objectives: To examine the medium‐term functional outcomes of partial nephrectomy for clinical T1b renal cell carcinoma, and to compare them with those of radical nephrectomy for clinical T1b and with those of partial nephrectomy for clinical T1a tumors. Methods: The participants of this study were patients operated for clinical T1a and clinical T1b tumors operated at Tokyo Women's Medical University, Tokyo, Japan, between January 1979 and June 2011. A total of 67 patients underwent partial nephrectomy for clinical T1b tumor, 195 patients underwent radical nephrectomy for clinical T1b tumors and 324 underwent partial nephrectomy for clinical T1a tumors. The outcomes of these three groups were compared. Results: Partial nephrectomy provided better preservation of residual renal function compared with radical nephrectomy for clinical T1b, and the postoperative estimated glomerular filtration rate was similar in the patients who underwent partial nephrectomy for clinical T1b and those who underwent partial nephrectomy for clinical T1a. Postoperative renal function was steadily maintained after partial nephrectomy during the medium‐term follow up. The probability of freedom from new onset of chronic kidney disease after partial nephrectomy for clinical T1b tumors was significantly higher from that after radical nephrectomy for clinical T1b tumors, and similar to that after partial nephrectomy for clinical T1a tumors. Conclusions: The higher anatomical complexity of clinical T1b tumors is unlikely to provide a significant influence on postoperative renal function after partial nephrectomy, when compared with the clinical T1a tumors. These findings support the beneficial role of partial nephrectomy in the preservation of renal function of clinical T1b renal cell carcinoma patients undergoing surgery.
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To review oncological and functional outcomes for partial nephrectomy in the setting of T2 tumors.We performed a comprehensive literature review on partial nephrectomy for T2 tumors, focusing on major primary series reporting oncological and functional outcomes, as well as complication rates in the last 10 years.Recent series have reported comparable oncological outcomes between partial nephrectomy and radical nephrectomy for ≥ T2 tumors. However, most of these studies are retrospective in design with small sample sizes. With regard to functional outcomes, partial nephrectomy outperforms radical nephrectomy. However, outcomes are dependent on the amount of residual renal parenchyma left after partial nephrectomy for larger tumors. Partial nephrectomy is associated with an increased rate of complications when compared to radical nephrectomy, but in experienced hands this increase tends to remain at an acceptable level. There are few studies that have investigated the role of minimally invasive surgery (MIS) in the setting of T2 tumors. Although MIS techniques may be underutilized for management of T2 tumors, it is a feasible approach in highly selected patients.Partial nephrectomy has emerged as an acceptable alternative for surgical management of T2 renal tumors over the last decade. Nephron-sparing surgery demonstrates similar oncological outcomes compared to radical nephrectomy and can be considered even for larger tumors in carefully selected patients whenever feasible.
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No AccessJournal of UrologyAdult Urology1 Mar 2012National Trends in the Use of Partial Nephrectomy: A Rising Tide That Has Not Lifted All Boats Sanjay G. Patel, David F. Penson, Baldeep Pabla, Peter E. Clark, Michael S. Cookson, Sam S. Chang, S. Duke Herrell, Joseph A. Smith, and Daniel A. Barocas Sanjay G. PatelSanjay G. Patel Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , David F. PensonDavid F. Penson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee Vanderbilt University Medical Center, Tennessee Valley Veterans Administration Health System, Nashville, Tennessee , Baldeep PablaBaldeep Pabla Vanderbilt University School of Medicine, Nashville, Tennessee , Peter E. ClarkPeter E. Clark Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , Michael S. CooksonMichael S. Cookson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , Sam S. ChangSam S. Chang Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , S. Duke HerrellS. Duke Herrell Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , Joseph A. SmithJoseph A. Smith Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee , and Daniel A. BarocasDaniel A. Barocas Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee View All Author Informationhttps://doi.org/10.1016/j.juro.2011.10.173AboutFull TextPDF Cite Export CitationSelect Citation formatNLMAMAIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Treatment of organ confined renal masses with partial nephrectomy has durable oncologic outcomes comparable to radical nephrectomy. Partial nephrectomy is associated with lower risk of chronic kidney disease and in some series with better overall survival. We report a contemporary analysis on national trends of partial nephrectomy use to determine partial nephrectomy use over time, and whether nontumor related factors such as structural attributes of the treating institution or patient characteristics are associated with the underuse of partial nephrectomy. Materials and Methods: We performed an analysis of the NIS (National Inpatient Sample), which contains 20% of all United States inpatient hospitalizations. We included patients who underwent radical or partial nephrectomy for a renal mass between 2002 and 2008. Survey weights were applied to obtain national estimates of nephrectomy use and to evaluate nonclinical predictors of partial nephrectomy. Results: A total of 46,396 patients were included in the study for a weighted sample of 226,493. There was an increase in partial nephrectomy use from 15.3% in 2002 to 24.7% in 2008 (p <0.001). On multivariate analysis hospital attributes (urban teaching status, nephrectomy volume, geographic region) and patient socioeconomic status (higher income ZIP code and private/HMO payer) were independent predictors of partial nephrectomy use. Conclusions: Since 2002 the national use of partial nephrectomy for the management of renal masses has increased. However, the adoption of partial nephrectomy at smaller, rural and nonacademic hospitals lags behind that of larger hospitals, urban/teaching hospitals and higher volume centers. A lower rate of partial nephrectomy use among patients without private insurance and those living in lower income ZIP code areas highlights the underuse of partial nephrectomy as a quality of care concern. References 1 : Increasing incidence of all stages of kidney cancer in the last 2 decades in the United States: an analysis of Surveillance, Epidemiology and End Results program data. J Urol2002; 167: 57. 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Smaldone M and Kutikov A (2012) Assessing the management of localized kidney cancerNature Reviews Urology, 10.1038/nrurol.2012.45, VOL. 9, NO. 4, (186-188), Online publication date: 1-Apr-2012. Volume 187Issue 3March 2012Page: 816-821 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordskidney neoplasmsphysician's practice patternsnephrectomyMetrics Author Information Sanjay G. Patel Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author David F. Penson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, Tennessee Vanderbilt University Medical Center, Tennessee Valley Veterans Administration Health System, Nashville, Tennessee More articles by this author Baldeep Pabla Vanderbilt University School of Medicine, Nashville, Tennessee More articles by this author Peter E. Clark Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Galil Medical. More articles by this author Michael S. Cookson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Endo. More articles by this author Sam S. Chang Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Sanofi-Aventis, Endo, Allergan and Centocor Ortho Biotech. More articles by this author S. Duke Herrell Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Aesculap Inc., Covidien Surgical Devices, Veran Medical Tech, Wilex and Galil Medical. More articles by this author Joseph A. Smith Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee Financial interest and/or other relationship with Steba Pharmaceuticals. More articles by this author Daniel A. 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No AccessJournal of UrologyAdult urology1 Feb 2008Radical Nephrectomy for pT1a Renal Masses May be Associated With Decreased Overall Survival Compared With Partial Nephrectomyis corrected byErratum R. Houston Thompson, Stephen A. Boorjian, Christine M. Lohse, Bradley C. Leibovich, Eugene D. Kwon, John C. Cheville, and Michael L. Blute R. Houston ThompsonR. Houston Thompson Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota , Stephen A. BoorjianStephen A. Boorjian Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota , Christine M. LohseChristine M. Lohse Department of Health Sciences Research, Mayo Medical School and Mayo Clinic, Rochester, Minnesota , Bradley C. LeibovichBradley C. Leibovich Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota , Eugene D. KwonEugene D. Kwon Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota , John C. ChevilleJohn C. Cheville Department of Laboratory Medicine and Pathology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota , and Michael L. BluteMichael L. Blute Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota View All Author Informationhttps://doi.org/10.1016/j.juro.2007.09.077AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We reviewed our surgical experience with small renal tumors, comparing overall survival in patients treated with radical and partial nephrectomy. Materials and Methods: Using our nephrectomy registry we identified patients with sporadic, unilateral, solitary and localized renal masses 4 cm or less who underwent radical or partial nephrectomy between 1989 and 2003. Patients with a solitary kidney or impaired renal function at presentation were excluded, leaving 648 available for analysis. Overall survival was estimated using the Kaplan-Meier method and associations with death were evaluated using Cox proportional hazards regression. Results: At last followup 146 patients had died of any cause and 502 were alive at a median of 7.1 years. Radical and partial nephrectomy was performed in 290 and 358 patients, respectively. In all patients radical nephrectomy was not significantly associated with death from any cause compared with partial nephrectomy (RR 1.12, p = 0.52). However, there was a significant interaction with age, leading us to stratify our analysis at the median age of 65 years. In 327 patients younger than 65 years radical nephrectomy was significantly associated with death from any cause compared with partial nephrectomy (RR 2.16, p = 0.02). 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1-Aug-2011.Young J, Khanifar E, Narula N, Ortiz-Vanderdys C, Kolla S, Pick D, Sountoulides P, Kaufmann O, Osann K, Huynh V, Kaplan A, Andrade L, Louie M, McDougall E and Clayman R (2011) Optimal Freeze Cycle Length for Renal CryotherapyJournal of Urology, VOL. 186, NO. 1, (283-288), Online publication date: 1-Jul-2011.Lane B, Gill I, Fergany A, Larson B and Campbell S (2011) Limited Warm Ischemia During Elective Partial Nephrectomy has Only a Marginal Impact on Renal Functional OutcomesJournal of Urology, VOL. 185, NO. 5, (1598-1603), Online publication date: 1-May-2011.Goldfarb D (2010) Renal Surgery—Is Technique More Important Than Tumor or Patient Characteristics in Preserving Kidney Function?Journal of Urology, VOL. 185, NO. 2, (383-384), Online publication date: 1-Feb-2011.Breau R, Crispen P, Jenkins S, Blute M and Leibovich B (2010) Treatment of Patients With Small Renal Masses: A Survey of the American Urological AssociationJournal of Urology, VOL. 185, NO. 2, (407-414), Online publication date: 1-Feb-2011.Schwartz M and Kavoussi L (2010) The Evolution of Renal Surgery for MalignancyJournal of Urology, VOL. 184, NO. 4, (1251-1252), Online publication date: 1-Oct-2010.Lane B, Fergany A, Weight C and Campbell S (2010) Renal Functional Outcomes After Partial Nephrectomy With Extended Ischemic Intervals are Better Than After Radical NephrectomyJournal of Urology, VOL. 184, NO. 4, (1286-1290), Online publication date: 1-Oct-2010.Liu N, Khurana K, Sudarshan S, Pinto P, Linehan W and Bratslavsky G (2010) Repeat Partial Nephrectomy on the Solitary Kidney: Surgical, Functional and Oncological OutcomesJournal of Urology, VOL. 183, NO. 5, (1719-1724), Online publication date: 1-May-2010.Lowrance W, Yee D, Savage C, Cronin A, O'Brien M, Donat S, Vickers A and Russo P (2010) Complications After Radical and Partial Nephrectomy as a Function of AgeJournal of Urology, VOL. 183, NO. 5, (1725-1730), Online publication date: 1-May-2010.Breau R, Crispen P, Jimenez R, Lohse C, Blute M and Leibovich B (2010) Outcome of Stage T2 or Greater Renal Cell Cancer Treated With Partial NephrectomyJournal of Urology, VOL. 183, NO. 3, (903-908), Online publication date: 1-Mar-2010.Lane B and Gill I (2009) 7-Year Oncological Outcomes After Laparoscopic and Open Partial NephrectomyJournal of Urology, VOL. 183, NO. 2, (473-479), Online publication date: 1-Feb-2010.Abouassaly R, Alibhai S, Tomlinson G, Timilshina N and Finelli A (2009) Unintended Consequences of Laparoscopic Surgery on Partial Nephrectomy for Kidney CancerJournal of Urology, VOL. 183, NO. 2, (467-472), Online publication date: 1-Feb-2010.Hakimi A, Rajpathak S, Chery L, Shapiro E and Ghavamian R (2009) Renal Insufficiency is an Independent Risk Factor for Complications After Partial NephrectomyJournal of Urology, VOL. 183, NO. 1, (43-47), Online publication date: 1-Jan-2010.Thompson R, Siddiqui S, Lohse C, Leibovich B, Russo P and Blute M (2009) Partial Versus Radical Nephrectomy for 4 to 7 cm Renal Cortical 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Potential in Renal Cell Carcinoma CasesJournal of Urology, VOL. 181, NO. 5, (2033-2036), Online publication date: 1-May-2009.Thompson R, Kaag M, Vickers A, Kundu S, Bernstein M, Lowrance W, Galvin D, Dalbagni G, Touijer K and Russo P (2009) Contemporary Use of Partial Nephrectomy at a Tertiary Care Center in the United StatesJournal of Urology, VOL. 181, NO. 3, (993-997), Online publication date: 1-Mar-2009.Huang W, Elkin E, Levey A, Jang T and Russo P (2008) Partial Nephrectomy Versus Radical Nephrectomy in Patients With Small Renal Tumors—Is There a Difference in Mortality and Cardiovascular Outcomes?Journal of Urology, VOL. 181, NO. 1, (55-62), Online publication date: 1-Jan-2009.Nadu A, Kleinmann N, Laufer M, Dotan Z, Winkler H and Ramon J (2008) Laparoscopic Partial Nephrectomy for Central Tumors: Analysis of Perioperative Outcomes and ComplicationsJournal of Urology, VOL. 181, NO. 1, (42-47), Online publication date: 1-Jan-2009.Lane B, Babineau D, Poggio E, Weight C, Larson B, Gill I and Novick A (2008) Factors Predicting Renal Functional Outcome After Partial NephrectomyJournal of Urology, VOL. 180, NO. 6, (2363-2369), Online publication date: 1-Dec-2008.Crispen P, Boorjian S, Lohse C, Sebo T, Cheville J, Blute M and Leibovich B (2008) Outcomes Following Partial Nephrectomy by Tumor SizeJournal of Urology, VOL. 180, NO. 5, (1912-1917), Online publication date: 1-Nov-2008.Thompson R, Ordonez M, Iasonos A, Secin F, Guillonneau B, Russo P and Touijer K (2008) Renal Cell Carcinoma in Young and Old Patients—Is There a Difference?Journal of Urology, VOL. 180, NO. 4, (1262-1266), Online publication date: 1-Oct-2008.Related articlesJournal of Urology9 Nov 2018Erratum Volume 179Issue 2February 2008Page: 468-473 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordsrenal cellcarcinomakidney neoplasmskidneymortalitynephrectomyMetricsAuthor Information R. Houston Thompson Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota More articles by this author Stephen A. Boorjian Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota More articles by this author Christine M. Lohse Department of Health Sciences Research, Mayo Medical School and Mayo Clinic, Rochester, Minnesota More articles by this author Bradley C. Leibovich Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota More articles by this author Eugene D. Kwon Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota More articles by this author John C. Cheville Department of Laboratory Medicine and Pathology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota More articles by this author Michael L. Blute Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota More articles by this author Expand All Advertisement PDF downloadLoading ...
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Partial nephrectomy has been considered an effective and efficient method in the treatment of localized renal cell carcinoma. Herein, we retrospectively review our experience with partial nephrectomy in the treatment of localized renal cell carcinoma and compared it with patients who received radical nephrectomy.From 1982 to 2005, 35 patients who received partial nephrectomy for localized renal cell carcinoma were enrolled in this study. Ten patients were female (28.6%). The median age was 70 years (range, 42-82 years). Sixteen (45.7%) patients had pathologic T1a tumors; 17 (48.6%) patients had pathologic T1b tumors and 2 (5.7%) patients had pathologicT2 tumor (7cm). In the meantime, 128 patients who had T1N0M0 renal cell carcinoma and who received radical nephrectomy were assigned to a control group. Thirty-nine patients (30.5%) were female in this group. The median age was 62 years (range, 30-83 years). The tumor characteristics, location, surgical techniques and patient survival were subsequently compared.The median tumor size in the partial nephrectomy group was 3.9cm (range, 1.5-7.0cm), and it was 4.5cm (range, 1-6.5cm) in radical nephrectomy group. The tumor size was smaller in the partial nephrectomy group (p = 0.003). Themedian follow-up period was 4.38 years (range, 0.05-17.99 years) in the partial nephrectomy group and 5.66 years (range, 0.01-22.25 years) in the radical nephrectomy group. There was no local recurrence or distant metastasis in the partial nephrectomy group. The 5-year overall survival was 85.0% compared with 91.4% in the radical nephrectomy group (p = 0.126). The 5-year disease specific survival in the partial nephrectomy group was 100%. The postoperative serum creatinine level increased to >2.0mg/dL in 5 (14.3%) patients in the partial nephrectomy group, but no patient needed hemodialysis during follow-up.From our review, partial nephrectomy is safe and provides excellent disease control in the treatment of localized renal cell carcinoma in selected patients. Renal function preservation was observed in the partial nephrectomy group, while the operated kidney showed functioning in the follow-up nuclear medicine survey.
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Purpose of review Provider volume has been shown to affect outcomes of various surgical procedures. Because of its technical complexity, it is likely that partial nephrectomy outcomes can be affected by hospital and/or surgeon volume. However, until recently, there were few publications on the subject. Our objective is to discuss recent findings on the impact of surgical volume on partial nephrectomy outcomes. Recent findings Two studies found a link between the number of partial nephrectomy performed at an institution and postoperative outcomes. Data extrapolated from articles on learning curve of laparoscopic partial nephrectomy suggest that surgeon volume can also affect partial nephrectomy outcomes. Partial nephrectomy is underused in low-volume centers. Robotic partial nephrectomy has a shorter learning curve compared to laparoscopic partial nephrectomy and may increase the use of partial nephrectomy vs. radical nephrectomy. Results on the impact of provider volume on the surgical approach are conflicting. Summary There are few publications suggesting an impact of hospital volume on partial nephrectomy outcomes but the importance of the surgeon volume remains unclear. Higher surgical volume is associated with increased use of partial nephrectomy.
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You have accessJournal of UrologyKidney Cancer: Localized: Ablative Therapy1 Apr 2018PD61-06 OUT COME OF PARTIAL NEPHRECTOMY IN T2 RCC. Abdus Salam, Mir Ehteshamul Haque, Faisal Islam, Kaiser Ibrahim, and Shahinul Islam Abdus SalamAbdus Salam More articles by this author , Mir Ehteshamul HaqueMir Ehteshamul Haque More articles by this author , Faisal IslamFaisal Islam More articles by this author , Kaiser IbrahimKaiser Ibrahim More articles by this author , and Shahinul IslamShahinul Islam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2830AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy for stage T1 renal cell carcinoma is oncologically efficacious and safe, and may have survival advantages. We describe our experience with partial nephrectomy for T2 or greater renal cell cancer. METHODS Between 2008 and 2013, 128 partial nephrectomies were done at our institution, including 13 for sporadic unilateral advanced stage tumors (pT2 in 8, pT3a in 3 and pT3 in 2). We reviewed outcomes in these patients compared to those in 20 cases treated with radical nephrectomy matched for stage, tumor size, baseline renal function, age and gender. RESULTS The risk of cancer specific and overall death was similar for partial nephrectomy. At a median of 3.2 years of follow up 1 patients with partial nephrectomy had metastatic disease vs (7.69%)with radical nephrectomy. Two patients (15.38%) with partial nephrectomy had isolated local recurrence vs (0%) with radical nephrectomy.In the partial nephrectomy group 2 (15.38%) and 1 cases (7.69%) were complicated by urine leak and retroperitoneal bleeding requiring intervention, respectively. The median serum creatinine increase was 11.5% vs 35% for partial vs radical nephrectomy (p <0.001). CONCLUSIONS Partial nephrectomy for T2 or greater renal cell carcinoma preserves renal function and appears to achieve oncological outcomes similar to those of radical nephrectomy. The role of partial nephrectomy in patients with T2-3 tumors and a normal contralateral kidney deserves further consideration and study. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1153 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Abdus Salam More articles by this author Mir Ehteshamul Haque More articles by this author Faisal Islam More articles by this author Kaiser Ibrahim More articles by this author Shahinul Islam More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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The advent of robotics may promote the dissemination of partial nephrectomy, and allow patients to experience survival and functional benefits compared to radical nephrectomy. Therefore, we assessed the impact of hospital acquisition of a robotic surgery platform on the rate of partial nephrectomy recorded in a nationwide database.We identified 53,364 patients with a diagnosis of localized renal cell carcinoma who underwent extirpative surgery from 2006 to 2012 using the Perspective database. Procedures were categorized based on extent of surgery (radical nephrectomy vs partial nephrectomy), approach (open, laparoscopic, robotic) and hospital ownership of a surgical robot. Changes in the proportion of partial nephrectomies performed over time and the effect of acquiring a surgical robot on the proportion of partial nephrectomies performed were assessed with multivariable logistic regression.Overall 40,147 (75.2%) radical nephrectomies and 13,217 (24.8%) partial nephrectomies were performed between 2006 and 2012. The proportion of hospitals using a surgical robot for renal cancer surgery increased from 1.8% in the first quarter of 2006 to 47.7% by the end of 2012. Partial nephrectomy use ranged from 19.1% to 31.2%. More robotic hospitals performed partial nephrectomy than nonrobotic hospitals (29.6% vs 18.0%, p <0.001). After acquisition of a surgical robot the partial nephrectomy rate increased from 16.4% to 34.3% (p <0.001). Hospitals with a robot were more likely to use partial nephrectomy than radical nephrectomy (OR 1.464, CI 1.39-1.54, p <0.001).While laparoscopic partial nephrectomy remains a challenging operation, this study demonstrates that hospital ownership of a surgical robot is associated with increased use of partial nephrectomy in the treatment of localized renal masses.
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