Maxine G B Tran1,2, Katja K H Aben3,4, Erik Werkhoven5, Joana B Neves1,2, Sarah Fowler6, Mark Sullivan7, Grant D Stewart8,9, Ben Challacombe10, Ahmed Mahrous2, Prasad Patki2, Faiz Mumtaz2, Ravi Barod2, Axel Bex1,2,3,5. 1. Division of Surgery and Interventional Science, University College London, London, UK. 2. Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK. 3. Netherlands Comprehensive Cancer Centre, Utrecht, The Netherlands. 4. Research Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands. 5. Netherlands Cancer Institute, Amsterdam, The Netherlands. 6. British Association of Urological Surgeons, London, UK. 7. Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 8. Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. 9. Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK. 10. Guy's and St Thomas' NHS Foundation Trust, London, UK.
Abstract
OBJECTIVE: To assess European Association of Urology guideline adherence on the surgical management of patients with T1 renal tumours and the effects of centralisation of care. PATIENTS AND METHODS: Retrospective data from all kidney tumours that underwent radical nephrectomy (RN) or partial nephrectomy (PN) in the period 2012-2016 from the British Association of Urological Surgeons Nephrectomy Audit were retrieved and analysed. We assessed total surgical hospital volume (HV; RN and PN performed) per centre, PN rates, complication rates, and completeness of data. Descriptive analyses were performed, and confidence intervals were used to illustrate the association between hospital volume and proportion of PN. Chi- squared and Cochran-Armitage trend tests were used to evaluate differences and trends. RESULTS: In total, 13 045 surgically treated T1 tumours were included in the analyses. Over time, there was an increase in PN use (39.7% in 2012 to 44.9% in 2016). Registration of the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) complexity score was included in March 2016 and documented in 39% of cases. Missing information on postoperative complications appeared constant over the years (8.5-9%). A clear association was found between annual HV and the proportion of T1 tumours treated with PN rather than RN (from 18.1% in centres performing <25 cases/year [lowest volume] to 61.8% in centres performing ≥100 cases/year [high volume]), which persisted after adjustment for PADUA complexity. Overall and major (Clavien-Dindo grade ≥III) complication rate decreased with increasing HV (from 12.2% and 2.9% in low-volume centres to 10.7% and 2.2% in high-volume centres, respectively), for all patients including those treated with PN. CONCLUSION: Closer guideline adherence was exhibited by higher surgical volume centres. Treatment of T1 tumours using PN increased with increasing HV, and was accompanied by an inverse association of HV with complication rate. These results support the centralisation of kidney cancer specialist cancer surgical services to improve patient outcomes.
OBJECTIVE: To assess European Association of Urology guideline adherence on the surgical management of patients with T1 renal tumours and the effects of centralisation of care. PATIENTS AND METHODS: Retrospective data from all kidney tumours that underwent radical nephrectomy (RN) or partial nephrectomy (PN) in the period 2012-2016 from the British Association of Urological Surgeons Nephrectomy Audit were retrieved and analysed. We assessed total surgical hospital volume (HV; RN and PN performed) per centre, PN rates, complication rates, and completeness of data. Descriptive analyses were performed, and confidence intervals were used to illustrate the association between hospital volume and proportion of PN. Chi- squared and Cochran-Armitage trend tests were used to evaluate differences and trends. RESULTS: In total, 13 045 surgically treated T1 tumours were included in the analyses. Over time, there was an increase in PN use (39.7% in 2012 to 44.9% in 2016). Registration of the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) complexity score was included in March 2016 and documented in 39% of cases. Missing information on postoperative complications appeared constant over the years (8.5-9%). A clear association was found between annual HV and the proportion of T1 tumours treated with PN rather than RN (from 18.1% in centres performing <25 cases/year [lowest volume] to 61.8% in centres performing ≥100 cases/year [high volume]), which persisted after adjustment for PADUA complexity. Overall and major (Clavien-Dindo grade ≥III) complication rate decreased with increasing HV (from 12.2% and 2.9% in low-volume centres to 10.7% and 2.2% in high-volume centres, respectively), for all patients including those treated with PN. CONCLUSION: Closer guideline adherence was exhibited by higher surgical volume centres. Treatment of T1 tumours using PN increased with increasing HV, and was accompanied by an inverse association of HV with complication rate. These results support the centralisation of kidney cancer specialist cancer surgical services to improve patient outcomes.
Authors: Teele Kuusk; David Cullen; Joana Briosa Neves; Nicholas Campain; Ravi Barod; Ekaterini Boleti; Soha El-Sheihk; Lee Grant; John Kelly; Marta Marchetti; Faiz Mumtaz; Prasad Patki; Navin Ramachandran; Pedro Silva; My-Anh Tran-Dang; Miles Walkden; Maxine G B Tran; Thomas Powles; Axel Bex Journal: BJU Int Date: 2021-05-25 Impact factor: 5.969
Authors: Scott C Brancato; Mansen Wang; Kateri J Spinelli; Maheer Gandhavadi; Neil K Worrall; Eric J Lehr; Zach M DeBoard; Torin P Fitton; Alison Leiataua; Jonathan P Piccini; Ty J Gluckman Journal: Heart Rhythm O2 Date: 2021-12-24