66 HAS A MINIMALLY INVASIVE APPROACH BECOME MORE IMPORTANT THAN NEPHRON PRESERVATION IN THE MANAGEMENT OF THE CLINICALLY LOCALIZED RENAL MASS? (2011)

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness1 Apr 201166 HAS A MINIMALLY INVASIVE APPROACH BECOME MORE IMPORTANT THAN NEPHRON PRESERVATION IN THE MANAGEMENT OF THE CLINICALLY LOCALIZED RENAL MASS? Marc Smaldone, Alexander Kutikov, Brian Egleston, Daniel Canter, Ervin Teper, Rosalia Viterbo, David Chen, Richard Greenberg, and Robert Uzzo Marc SmaldoneMarc Smaldone Philadelphia, PA More articles by this author , Alexander KutikovAlexander Kutikov Philadelphia, PA More articles by this author , Brian EglestonBrian Egleston Philadelphia, PA More articles by this author , Daniel CanterDaniel Canter Philadelphia, PA More articles by this author , Ervin TeperErvin Teper Philadelphia, PA More articles by this author , Rosalia ViterboRosalia Viterbo Philadelphia, PA More articles by this author , David ChenDavid Chen Philadelphia, PA More articles by this author , Richard GreenbergRichard Greenberg Philadelphia, PA More articles by this author , and Robert UzzoRobert Uzzo Philadelphia, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.130AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The AUA guidelines for the management of localized renal masses highlight the importance of oncologic efficacy, nephron preservation, and the use of minimally invasive techniques when appropriate. Using SEER-Medicare data we examined the impact of laparoscopy on utilization of nephron sparing techniques from 1995–2005. METHODS Using linked SEER-Medicare data, we examined national trends in utilization of open radical nephrectomy (ORN), laparoscopic radical nephrectomy (LRN), open partial nephrectomy (OPN), and laparoscopic partial nephrectomy (LPN) in patients with localized (stage I/II) renal masses from 1995–2005. Linked data was not available after 2005. Data were analyzed using ANOVAs, chi-squared tests, and logistic regression analysis. RESULTS 6,716 patients (mean age 74.2±5.7 years, 53.4% male) who underwent surgery for clinically localized tumors (mean tumor size of 4.8±3.2cm) were identified. Comparing patients undergoing ORN, LRN, OPN, and LPN, significant differences were observed in age (p<0.001), gender (p=0.01), tumor stage (p<0.001), and tumor size (p<0.001). When evaluated over time, the rates of ORN decreased while for each year successive year, patients were more likely to be treated with OPN (OR 1.18, CI 1.14–1.21), LRN (OR 1.44, CI 1.40–1.48) and LPN (OR 1.68, CI 1.56–1.81). Comparing utilization trends in 1995 and 2005, there was a marked reduction in number of patients undergoing ORN (86.7% vs. 36.4%, p<0.001). However, while the increased utilization of OPN (6.7% vs. 13.5%, p=0.001) and LPN (0.6% vs. 9.3%, p<0.001) reached statistical significance, this was offset by a marked increase in LRN over the same time period (6.1% vs. 40.8%, p<0.001). As a result, utilization of nephron sparing techniques increased by only 15.5% over the ten year period, with 77% of identified patients with localized tumors still managed with radical nephrectomy in 2005. CONCLUSIONS Recent evidence suggests that nephron sparing surgery reduces the risk of chronic kidney disease and may impact survival in patients with renal cell carcinoma. While rates of ORN for clinically localized renal masses have decreased by 50% since 1995 there has been a two fold rise in the utilization of LRN when compared to partial nephrectomy. The trade off of minimally invasive surgery for nephron preservation may have adverse long term consequences. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e29 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marc Smaldone Philadelphia, PA More articles by this author Alexander Kutikov Philadelphia, PA More articles by this author Brian Egleston Philadelphia, PA More articles by this author Daniel Canter Philadelphia, PA More articles by this author Ervin Teper Philadelphia, PA More articles by this author Rosalia Viterbo Philadelphia, PA More articles by this author David Chen Philadelphia, PA More articles by this author Richard Greenberg Philadelphia, PA More articles by this author Robert Uzzo Philadelphia, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...