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

2009; Lippincott Williams & Wilkins; Volume: 181; Issue: 3 Linguagem: Inglês

10.1016/j.juro.2008.11.017

1527-3792

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

Chronic Kidney Disease and Diabetes

No AccessJournal of UrologyAdult Urology1 Mar 2009Contemporary 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, and Paul Russo R. Houston ThompsonR. Houston Thompson , Matt KaagMatt Kaag , Andrew VickersAndrew Vickers , Shilajit KunduShilajit Kundu , Melanie BernsteinMelanie Bernstein , William LowranceWilliam Lowrance , David GalvinDavid Galvin , Guido DalbagniGuido Dalbagni , Karim TouijerKarim Touijer , and Paul RussoPaul Russo View All Author Informationhttps://doi.org/10.1016/j.juro.2008.11.017AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail 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. References 1 : Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol2006; 7: 735. Google Scholar 2 : Complications of contemporary open nephron sparing surgery: a single institution experience. J Urol2005; 174: 855. 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Volume 181Issue 3March 2009Page: 993-997 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordskidney neoplasmscarcinomanephrectomymortalityrenal cellkidneyMetricsAuthor Information R. Houston Thompson More articles by this author Matt Kaag More articles by this author Andrew Vickers More articles by this author Shilajit Kundu More articles by this author Melanie Bernstein More articles by this author William Lowrance More articles by this author David Galvin More articles by this author Guido Dalbagni More articles by this author Karim Touijer More articles by this author Paul Russo More articles by this author Expand All Advertisement PDF downloadLoading ...