Aim: Recent trends in surgery for the renal mass indicate that the type of surgery performed may depend largely on surgeon practice style. Since 2004 we have used an interdisciplinary approach for the surgical treatment of the renal mass. We report the results of this practice including oncologic and surgical outcomes.
Methods: A prospective database of patients undergoing treatment for renal mass was analyzed. Minimally invasive surgery (MIS) was performed by a laparoscopist, and open surgery was performed by a urologic oncologist. Demographic and clinicopathologic data were compared between treatment groups using nonparametric analysis of variance.
Results: Of 120 patients treated for renal mass, 34% were treated after internal referral, 34% with nephron sparing surgery (NSS), 68% with MIS, and 32% with open surgery. Internal referrals accounted for 77% of patients who underwent open partial nephrectomy (OPN), 32% who underwent open radical nephrectomy (ORN), and 26% who underwent MIS. There were no significant differences in gender, mean ASA, or smoking history between groups. Patients in the ORN group were more likely symptomatic (P<0.001). Patients undergoing ORN or LRN had larger tumors than those undergoing open or laparoscopic partial nephrectomy (OPN and LPN) (P<0.001). Tumor stage, grade, and positive margin rate were highest in the ORN group (P<0.001). Hospital stay was shortest in the MIS and NSS groups (P<0.001). Complications were not different between groups.
Conclusion: An interdisciplinary approach to the treatment of renal mass involving both a laparoscopist and urologic oncologist may reduce the impact of surgeon practice style on the type of surgery performed.