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Development of a Novel Scoring System Quantifies Opportunities to Reduce Surgery for Benign Renal Neoplasms: A Retrospective Quality Improvement Analysis within the MUSIC-KIDNEY Collaborative

2020; Lippincott Williams & Wilkins; Volume: 204; Issue: 6 Linguagem: Inglês

10.1097/ju.0000000000001238

1527-3792

Henry Peabody, A. K. Patel, Anna Johnson, Mahin Mirza, Sabrina L. Noyes, Edward Schervish, Sanjeev Kaul, Craig Rogers, Brian R. Lane, Alice Semerjian,

Ureteral procedures and complications

No AccessJournal of UrologyAdult Urology1 Dec 2020Development of a Novel Scoring System Quantifies Opportunities to Reduce Surgery for Benign Renal Neoplasms: A Retrospective Quality Improvement Analysis within the MUSIC-KIDNEY CollaborativeThis article is commented on by the following:Editorial Comment Henry Peabody, IV Amit Patel, Anna Johnson, Mahin Mirza, Sabrina L. Noyes, Edward Schervish, Sanjeev Kaul, Craig G. Rogers, Brian R. Lane, and Alice Semerjianfor the Michigan Urological Surgery Improvement Collaborativec Henry PeabodyHenry Peabody Spectrum Health Hospital System, Grand Rapids, Michigan , Amit PatelAmit Patel Henry Ford Health System, Detroit, Michigan , Anna JohnsonAnna Johnson Michigan Medicine, Ann Arbor, Michigan , Mahin MirzaMahin Mirza Michigan Medicine, Ann Arbor, Michigan , Sabrina L. NoyesSabrina L. Noyes Spectrum Health Hospital System, Grand Rapids, Michigan , Edward SchervishEdward Schervish Michigan Institute of Urology, St. Clair Shores, Michigan , Sanjeev KaulSanjeev Kaul Comprehensive Urology, William Beaumont Hospital, Royal Oak, Michigan , Craig G. RogersCraig G. Rogers Henry Ford Health System, Detroit, Michigan , Brian R. LaneBrian R. Lane Spectrum Health Hospital System, Grand Rapids, Michigan Michigan State University College of Human Medicine, Grand Rapids, Michigan , and Alice Semerjianfor the Michigan Urological Surgery Improvement CollaborativecAlice Semerjian *Correspondence: Saint Joseph Mercy Ann Arbor Hospital, Ann Arbor, Michigan E-mail Address: [email protected] IHA Urology, St. Joseph Mercy Hospital, Ann Arbor, Michigan View All Author Informationhttps://doi.org/10.1097/JU.0000000000001238AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Nonmalignant pathology has been reported in 15% to 20% of surgeries for cT1 renal masses. We seek to identify opportunities for improvement in avoiding surgery for nonmalignant pathology. Materials and Methods: MUSIC-KIDNEY started collecting data in 2017. All patients with cT1 renal masses who had partial or radical nephrectomy for nonmalignant pathology were identified. Category for improvement (none—0, minor—1, moderate—2 or major—3) was independently assigned to each case by 5 experienced kidney surgeons. Specific strategies to decrease nonmalignant pathology were identified. Results: Of 1,392 patients with cT1 renal masses 653 underwent surgery and 74 had nonmalignant pathology (11%). Of these, 23 (31%) cases were cT1b. Radical nephrectomy was performed in 17 (22.9%) patients for 5 cT1a and 12 cT1b lesions. Only 6 patients had a biopsy prior to surgery (5 oncocytoma, 1 unclassified renal cell carcinoma). Review identified 25 cases with minor (34%), 26 with moderate (35%) and 10 with major (14%) quality improvement opportunities. Overall 17% of cases had no quality improvement opportunities identified (12 partial nephrectomy, 1 radical nephrectomy). Conclusions: Review of patients with cT1 renal masses who underwent surgery for nonmalignant pathology revealed a significant number of cases in which this outcome may have been avoided. Approximately half of cases had moderate or major quality improvement opportunities, with radical nephrectomy for nonmalignant pathology being the most common reason. Our data indicate a lowest achievable and acceptable rate of nonmalignant pathology to be 1.9% and 5.4%, respectively. Avoiding interventions for nonmalignant pathology, particularly radical nephrectomy, is an important focus of quality improvement efforts. Strategies to decrease unnecessary interventions for nonmalignant pathology include greater use of repeat imaging, renal mass biopsy and surveillance. References 1. American Cancer Society: Cancer Facts & Figures 2020. Atlanta: American Cancer Society 2020. Google Scholar 2. : Renal cell cancer stage migration: analysis of the National Cancer Data Base. Cancer 2008; 113: 78. Google Scholar 3. : Clinical stage migration and survival for renal cell carcinoma in the United States. Eur Urol Oncol 2019; 2: 343. Google Scholar 4. : Preoperatively misclassified, surgically removed benign renal masses: a systematic review of surgical series and United States population level burden estimate. J Urol 2014; 193: 30. Google Scholar 5. : Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging. Urology 2006; 68: 737. Google Scholar 6. : Prediction of renal mass aggressiveness using clinical and radiographic features: a global, multicentre prospective study. BJU Int 2016; 117: 914. Google Scholar 7. : Partial nephrectomy for presumed renal-cell carcinoma: incidence, predictors, and perioperative outcomes of benign lesions. J Endourol 2017; 31: 412. Google Scholar 8. : Predicting complications following robot-assisted partial nephrectomy with the ACS NSQIP® universal surgical risk calculator. J Urol 2017; 198: 803. Link, Google Scholar 9. : Renal mass and localized renal cancer: AUA Guideline. J Urol 2017; 198: 520. Link, Google Scholar 10. : Selecting patients with small renal masses for active surveillance: a domain based score from a prospective cohort study. J Urol 2019; 201: 886. Link, Google Scholar 11. : Comparative effectiveness of management options for patients with small renal masses: a prospective cohort study. BJU Int 2019; 123: 42. Google Scholar 12. : Metastatic renal cell carcinoma risk according to tumor size. J Urol 2009; 182: 41. Link, Google Scholar 13. : Metastatic potential of a renal mass according to original tumor size at presentation. BJU Int 2012; 109: 190. Google Scholar 14. : Evolving trends for selected treatments of T1a renal cell carcinoma. Urology 2019; 132: 136. Google Scholar 15. : The harms of overdiagnosis and overtreatment in patients with small renal masses: a mini-review. Eur Urol Focus 2019; 5: 943. Google Scholar 16. : Use of delayed intervention for small renal masses initially managed with active surveillance. Urol Oncol 2019; 37: 18. Google Scholar 17. : Utilization of renal mass biopsy in patients with renal cell carcinoma. Urology 2014; 83: 774. Google Scholar 18. : Practice patterns of renal mass biopsy across MUSIC KIDNEY, a statewide collaborative. J Urol, suppl., 2020; 203: e1232. Google Scholar 19. : Management of renal masses and localized renal cancer: systematic review and meta-analysis. J Urol 2016: 196: 989. Link, Google Scholar 20. : Grade heterogeneity in small renal masses: potential implications for renal mass biopsy. J Urol 2015; 193: 36. Link, Google Scholar 21. : Renal mass biopsy is associated with reduction in surgery for early stage kidney cancer. Urology 2020; 135: 76. Google Scholar 22. : Anatomic features of enhancing renal masses predict malignant and high-grade pathology: a preoperative nomogram using the RENAL nephrometry score. Eur Urol 2011; 60: 241. Google Scholar 23. : Preoperative preductors of malignancy and unfavorable pathology for clinical T1a tumors treated with partial nephrectomy: a multi-institutional analysis. Urol Oncol 2015; 33: 112. Google Scholar 24. : Prospective evaluation of (99m)Tc-sestamibi SPECT/CT for the diagnosis of renal oncocytomas and hybrid oncocytic/chromophobe tumors. Eur Urol 2016; 69: 413. Google Scholar 25. : Analysis of survival for patients with chronic kidney disease primarily related to renal cancer surgery. BJU Int 2018; 121: 93. Google Scholar 26. : Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296. Google Scholar Supported by the Value Partnerships program at Blue Cross Blue Shield of Michigan, and the Betz Family Endowment for Cancer Research (RG0813-1036) through the Spectrum Health Foundation. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of UrologySep 24, 2020, 12:00:00 AMEditorial Comment Volume 204Issue 6December 2020Page: 1160-1165 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordskidneyquality improvementnephrectomybiopsyAcknowledgmentsThe authors would like to acknowledge the significant contributions of the clinical champions, urologists and data abstractors in each participating MUSIC practice.MetricsAuthor Information Henry Peabody Spectrum Health Hospital System, Grand Rapids, Michigan More articles by this author Amit Patel Henry Ford Health System, Detroit, Michigan More articles by this author Anna Johnson Michigan Medicine, Ann Arbor, Michigan More articles by this author Mahin Mirza Michigan Medicine, Ann Arbor, Michigan More articles by this author Sabrina L. Noyes Spectrum Health Hospital System, Grand Rapids, Michigan More articles by this author Edward Schervish Michigan Institute of Urology, St. Clair Shores, Michigan More articles by this author Sanjeev Kaul Comprehensive Urology, William Beaumont Hospital, Royal Oak, Michigan More articles by this author Craig G. Rogers Henry Ford Health System, Detroit, Michigan More articles by this author Brian R. Lane Spectrum Health Hospital System, Grand Rapids, Michigan Michigan State University College of Human Medicine, Grand Rapids, Michigan More articles by this author Alice Semerjianfor the Michigan Urological Surgery Improvement Collaborativec IHA Urology, St. Joseph Mercy Hospital, Ann Arbor, Michigan *Correspondence: Saint Joseph Mercy Ann Arbor Hospital, Ann Arbor, Michigan E-mail Address: [email protected] More articles by this author Expand All Supported by the Value Partnerships program at Blue Cross Blue Shield of Michigan, and the Betz Family Endowment for Cancer Research (RG0813-1036) through the Spectrum Health Foundation. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Advertisement Loading ...