Luka Flegar1, Christer Groeben1, Rainer Koch1, Martin Baunacke1, Angelika Borkowetz1, Klaus Kraywinkel2, Christian Thomas1, Johannes Huber3. 1. Department of Urology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany. 2. National Center for Cancer Registry Data, Robert Koch Institute, Berlin, Germany. 3. Department of Urology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany. johannes.huber@uniklinikum-dresden.de.
Abstract
BACKGROUND: Nephron-sparing surgery (NSS) is the treatment of choice for T1 renal tumors. This study compared the implementation of NSS in the United States and Germany. METHODS: Data were derived from the National Inpatient Sample and from the Nationwide German Hospital Billing Database. All cases of NSS and radical nephrectomy from 2006 to 2014 were analyzed. To assess tumor stage distribution, data from the Surveillance, Epidemiology, and End Results database (United States) and from German cancer registries were used. RESULTS: The study identified 74,663 cases in the United States and 130,051 cases in Germany. The proportion of NSS for T1 tumors increased from 30.6 to 57% in the United States compared with 38.5 to 72.9% (estimation) in Germany (p < 0.001). The proportion of robotic NSS increased from 0 to 54.5% in the United States (p < 0.001) and from 0.2 to 8.6% in Germany (p < 0.001). In a multivariate model, hospitals with higher annual caseloads and a surgical robot favored NSS. CONCLUSION: Patients with renal tumors might receive inhomogeneous care based on the resources of the treating institution. The robotic approach is a key driver for better implementation of NSS in the United States, and relevant potential still may exist for more organ preservation.
BACKGROUND: Nephron-sparing surgery (NSS) is the treatment of choice for T1 renal tumors. This study compared the implementation of NSS in the United States and Germany. METHODS: Data were derived from the National Inpatient Sample and from the Nationwide German Hospital Billing Database. All cases of NSS and radical nephrectomy from 2006 to 2014 were analyzed. To assess tumor stage distribution, data from the Surveillance, Epidemiology, and End Results database (United States) and from German cancer registries were used. RESULTS: The study identified 74,663 cases in the United States and 130,051 cases in Germany. The proportion of NSS for T1 tumors increased from 30.6 to 57% in the United States compared with 38.5 to 72.9% (estimation) in Germany (p < 0.001). The proportion of robotic NSS increased from 0 to 54.5% in the United States (p < 0.001) and from 0.2 to 8.6% in Germany (p < 0.001). In a multivariate model, hospitals with higher annual caseloads and a surgical robot favored NSS. CONCLUSION:Patients with renal tumors might receive inhomogeneous care based on the resources of the treating institution. The robotic approach is a key driver for better implementation of NSS in the United States, and relevant potential still may exist for more organ preservation.
Authors: J Madison Hyer; Aslam Ejaz; Adrian Diaz; Diamantis I Tsilimigras; Faiz Gani; Susan White; Timothy M Pawlik Journal: Ann Surg Date: 2019-09 Impact factor: 12.969
Authors: Luka Flegar; Aristeidis Zacharis; Cem Aksoy; Hendrik Heers; Marcus Derigs; Nicole Eisenmenger; Angelika Borkowetz; Christer Groeben; Johannes Huber Journal: World J Urol Date: 2022-05-13 Impact factor: 3.661
Authors: K F Kowalewski; D Müller; J Mühlbauer; J D Hendrie; T S Worst; F Wessels; M T Walach; J von Hardenberg; P Nuhn; P Honeck; M S Michel; M C Kriegmair Journal: World J Urol Date: 2020-08-19 Impact factor: 4.226