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BJU Int. 2016 Jan;117(1):62-71. doi: 10.1111/bju.13114. Epub 2015 May 13.

Partial vs radical nephrectomy for T1 renal tumours: an analysis from the British Association of Urological Surgeons Nephrectomy Audit.

Collaborators (219)

Abbasi Z, Adamson AS, Adeyoju AA, Adshead JM, Aho TF, Al-Akraa M, Allan J, Almond DJ, Anderson CJ, Andrew SJ, Apakama I, Armitage T, Banerjee GK, Barber NJ, Basu S, Bdesha AS, Beatty J, Bell CR, Bhanot SM, Bhatt R, Biyani CS, Blake C, Boddy J, Bromage SJ, Bromwich E, Browning AJ, Bryan NP, Burgess NA, Burns-Cox N, Butterworth PC, Bycroft J, Campbell I, Cannon A, Carter CJ, Carter PG, Cartledge JJ, Casey R, Chakravarti A, Chappell BG, Chen TF, Cherian J, Choi WH, Clavijo Eisele J, Cliff AM, Cohen NP, Cole OJ, Collins J, Connolly S, Cooke PW, Cornaby AJ, Corr JG, Coulthard R, Cresswell J, Crundwell MC, Cynk M, Daruwala PD, Datta SN, Davenport K, de Bolla AR, Devarajan R, Doherty AP, Donaldson PJ, Dyer J, Eaton J, Eddy B, Eden CG, Fiala R, Foster MC, Frymann RJ, Gall ZJ, Gana HB, Garnett S, Gibbons N, Gillatt DA, Godbole HC, Gowardhan B, Gujral S, Gunendran T, Haldar N, Hanbury DC, Hawkyard SJ, Haynes MD, Henderson A, Hicks JA, Hindley RG, Hodgson DJ, Hotston M, Howell GP, Hrouda D, Ilie C, Jain S, Janjua KS, Javle P, Johnson MI, Johnson P, Joshi H, Joyce AD, Keeley FX, Kelkar A, Kelleher JP, Khattak AQ, Kimuli M, Kirollos MM, Kockelbergh RC, Kooiman G, Kumar P, Kynaston HG, Laniado ME, Larner T, Latif Z, Lau MW, le Roux PJ, Leung S, Leveckis J, Lewis G, Lockyer CR, Lodge RN, Lynch M, Lynn NN, MacDermott JP, Madaan S, Maddineni SB, Maheshkumar P, Makar AA, Makunde JT, Manikandan R, Mann GS, Mantle M, Mark IR, Matanhelia SS, McClinton S, McInerney PD, McIntyre IG, McLarty E, McLoughlin J, McNeill SA, Mehta S, Mellon JK, Menezes P, Mills RD, Mokete M, Montague R, Motiwala HG, Mulholland CK, Mumtaz FH, Munro N, Myatt A, Nathan S, Neilson D, Nicol DL, Oades G, Oakley N, O'Brien TS, O'Kane HF, Okeke AA, O'Riordan A, Paez E, Page T, Parkin J, Patel N, Patel P, Pathak S, Patil K, Payne D, Phillips JT, Phillips SM, Phipps S, Pillai MK, Potter JM, Rajan TN, Rajjayabun P, Rane A, Ravi R, Ravichandran S, Richmond PJ, Riddick AC, Rimington PD, Rix D, Rix GH, Rochester M, Rowe E, Sahadevan K, Sandhu S, Sangar VK, Sells H, Shackley DC, Shah Z, Shaikh NN, Sharma H, Sherwood B, Singh S, Solomon L, Sriprasad SI, Stubington SR, Taneja S, Thilagarajah R, Thomas B, Thomas DJ, Thurston AV, Turner KJ, Umez-Eronini ON, Vale JA, Varadaraj H, Vesey SG, Viney R, Walton T, Waymont B, Webster JJ, Wedderburn A, Wemyss-Holden GD, Weston R, Whittlestone T, Wilkinson B, Wilkinson S, Williams S, Wills MI, Wilson JR, Woodhouse CR, Yates DR.

Author information

1
Department of Urology, Darent Valley Hospital, Dartford, Kent, UK.
2
British Association of Urological Surgeons, London, UK.
3
Department of Urology, St James's University Hospital, Leeds, UK.
4
Bristol Urological Institute, Southmead Hospital, Bristol, UK.

Erratum in

Abstract

OBJECTIVES:

To analyse and compare data from the British Association of Urological Surgeons Nephrectomy Audit for perioperative outcomes of partial (PN) and radical nephrectomy (RN) for T1 renal tumours.

PATIENTS AND METHODS:

UK consultants were invited to submit data on all patients undergoing nephrectomy between 1 January and 31 December 2012 to a nationally established database using a standard pro forma. Analysis was made on patient demographics, operative technique, and perioperative data/outcome between PN and RN for T1 tumours.

RESULTS:

Overall, data from 6 042 nephrectomies were reported of which 1 768 were performed for T1 renal tumours. Of these, 1 082 (61.2%) were RNs and 686 (38.8%) were PNs. The mean age of patients undergoing PN was lower (PN 59 years vs RN 64 years; P < 0.001) and so was the WHO performance score (PN 0.4 vs RN 0.7; P < 0.001). PN for the treatment of T1a tumours (≤4 cm) accounted for 55.6% of procedures, of which 43.9% were performed using a minimally invasive technique. For T1b tumours (4-7 cm), 18.9% of patients underwent PN, in 33.3% of which a minimally invasive technique was adopted. The vast majority of RNs for T1 tumours were performed using a minimally invasive technique (90.3%). Of the laparoscopic PNs, 30.5% were robot-assisted. There was no significant difference in overall intraoperative complications between the RN and PN groups (4% vs 4.3%; P = 0.79). However, PN accounted for a higher overall postoperative complications rate (RN 11.3% vs PN 17.6%; P < 0.001). RN was associated with a markedly reduced risk of severe surgical complications (Clavien Dindo classification grade ≥3) compared with PN even after adjusting for technique (odds ratio 0.30; P = 0.002). Operation time between RN and PN was comparable (141 vs 145 min; P = 0.25). Blood loss was less in the RN group (mean for RN 165 vs PN 323 mL; P < 0.001); however, transfusion rates were similar (3.2% vs 2.6%; P = 0.47). RN was associated with a shorter length of stay (median 4 vs 5 days; P < 0.001). A direct comparison between robot-assisted and laparoscopic PN showed no significant differences in operation time, blood loss, warm ischaemia time, and intraoperative and postoperative complications.

CONCLUSIONS:

PN was the method of choice for treatment of T1a tumours whereas RN was preferred for T1b tumours. Minimally invasive techniques have been widely adopted for RN but not for PN. Despite the advances in surgical technique, a substantial risk of postoperative complications remains with PN.

KEYWORDS:

BAUS; audit; outcomes; partial nephrectomy; perioperative; radical nephrectomy

PMID:
25754386
DOI:
10.1111/bju.13114
[Indexed for MEDLINE]
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