BACKGROUND: Despite increasing interest in minimally invasive surgery, prevalence data are completely absent. Our objective was to analyze clinico-epidemiological variations of surgery for renal malignancy in Japan with emphasis on annual trends and regional gaps, and to analyze factors affecting choice of open versus minimally invasive surgery. METHODS: We identified patients who underwent open (n = 8646), laparoscopic (n = 5932), or minimum incision endoscopic surgery (MIES) (n = 381) nephrectomy for renal malignancy, using the Japanese Diagnosis Procedure Combination database, 2007-2010. Clinical and regional variations in these three approaches were determined, and the annual per-population incidence of nephrectomy was estimated. Multivariate logistic regression was used to analyze factors affecting choice of minimally invasive surgery (laparoscopy or MIES). RESULTS: The proportion of open nephrectomy decreased from 65.3 % in 2007 to 51.6 % in 2010. Laparoscopic nephrectomy accounted for 51.0 % of procedures for T1 tumors. The estimated incidence of nephrectomy in males and females was 14.3 and 6.1 per 100,000 person-years, respectively. Multivariate analysis showed that minimally invasive nephrectomy was more likely to be selected for patients in their 30-50s who had less comorbidity, better performance status, or lower TNM stage, in high-volume or academic hospitals, especially in western Japan. Hemodialysis use was a favorable factor. CONCLUSION: Despite differences between eastern and western Japan, minimally invasive surgery is becoming widespread throughout Japan, especially for patients with low operative risks and early-stage cancer who are hospitalized in high-volume institutes.
BACKGROUND: Despite increasing interest in minimally invasive surgery, prevalence data are completely absent. Our objective was to analyze clinico-epidemiological variations of surgery for renal malignancy in Japan with emphasis on annual trends and regional gaps, and to analyze factors affecting choice of open versus minimally invasive surgery. METHODS: We identified patients who underwent open (n = 8646), laparoscopic (n = 5932), or minimum incision endoscopic surgery (MIES) (n = 381) nephrectomy for renal malignancy, using the Japanese Diagnosis Procedure Combination database, 2007-2010. Clinical and regional variations in these three approaches were determined, and the annual per-population incidence of nephrectomy was estimated. Multivariate logistic regression was used to analyze factors affecting choice of minimally invasive surgery (laparoscopy or MIES). RESULTS: The proportion of open nephrectomy decreased from 65.3 % in 2007 to 51.6 % in 2010. Laparoscopic nephrectomy accounted for 51.0 % of procedures for T1 tumors. The estimated incidence of nephrectomy in males and females was 14.3 and 6.1 per 100,000 person-years, respectively. Multivariate analysis showed that minimally invasive nephrectomy was more likely to be selected for patients in their 30-50s who had less comorbidity, better performance status, or lower TNM stage, in high-volume or academic hospitals, especially in western Japan. Hemodialysis use was a favorable factor. CONCLUSION: Despite differences between eastern and western Japan, minimally invasive surgery is becoming widespread throughout Japan, especially for patients with low operative risks and early-stage cancer who are hospitalized in high-volume institutes.
Authors: S Reza Ghasemian; Roberto Pedraza; Truman A Sasaki; Jimmy A Light; Sunil V Patel Journal: J Laparoendosc Adv Surg Tech A Date: 2005-12 Impact factor: 1.878
Authors: Nawar Hanna; Maxine Sun; Quoc-Dien Trinh; Jens Hansen; Marco Bianchi; Francesco Montorsi; Shahrokh F Shariat; Markus Graefen; Paul Perrotte; Pierre I Karakiewicz Journal: Eur Urol Date: 2011-12-22 Impact factor: 20.096
Authors: Hude Quan; Vijaya Sundararajan; Patricia Halfon; Andrew Fong; Bernard Burnand; Jean-Christophe Luthi; L Duncan Saunders; Cynthia A Beck; Thomas E Feasby; William A Ghali Journal: Med Care Date: 2005-11 Impact factor: 2.983
Authors: Inderbir S Gill; Louis R Kavoussi; Brian R Lane; Michael L Blute; Denise Babineau; J Roberto Colombo; Igor Frank; Sompol Permpongkosol; Christopher J Weight; Jihad H Kaouk; Michael W Kattan; Andrew C Novick Journal: J Urol Date: 2007-05-11 Impact factor: 7.450
Authors: Y Homma; K Kawabe; T Kitamura; Y Nishimura; M Shinohara; Y Kondo; I Saito; S Minowada; Y Asakage Journal: Int J Urol Date: 1995-05 Impact factor: 3.369
Authors: Andre Berger; Ricardo Brandina; Mohamed A Atalla; Amin S Herati; Kazumi Kamoi; Monish Aron; Georges-Pascal Haber; Robert J Stein; Mihir M Desai; Louis R Kavoussi; Inderbir S Gill Journal: J Urol Date: 2009-09-16 Impact factor: 7.450