Perioperative Morbidity of Open Versus Minimally Invasive Partial Nephrectomy: A Contemporary Analysis of the National Surgical Quality Improvement Program

Pereira, Jorge; Renzulli, Joseph; Pareek, Gyan; Moreira, Daniel de Carvalho; Guo, Ruiting; Zhang, Zheng; Amin, Ali; Mega, Anthony; Golijanin, Dragan; Gershman, Boris

doi:10.1089/end.2017.0609

Cited by 27 publications

(17 citation statements)

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“…Partial nephrectomy (PN) represents the gold standard for active treatment of cT1 renal masses [1][2][3]. Minimally invasive approaches such as laparoscopy or robotic surgery might offer similar oncological efficacy [4] and better perioperative outcomes [4][5][6] when compared with the open technique. However, given the lack of high-quality evidence, the current EAU guidelines do not recommend a surgical approach over the other [1].…”

Section: Introductionmentioning

confidence: 99%

“…Accordingly, a clear need of a standardized proxy for surgical quality has raised. Previous studies investigated surgical margins status [7], complications rate [6], and intraoperative ischemia time [8] to compare different surgical techniques. Recently, these three parameters have been combined in the trifecta [9], used to describe favorable outcomes after PN, and considered a proxy for surgical quality.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Outcomes of Open, Laparoscopic, and Robotic Partial Nephrectomy: A Prospective Multicenter Observational Study (The RECORd 2 Project)

Bravi

Larcher

Capitanio

et al. 2021

European Urology Focus

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Background: Partial nephrectomy (PN) has a non-negligible perioperative morbidity. Comparative evidence of the available surgical techniques is limited. Objective: To compare the perioperative outcomes of open, laparoscopic, and robotic PN. Methods: Data of 2331 patients treated with PN for cT1 renal tumors were extracted from the RECORd2 database, a prospective multicenter project. Multivariable regression models assessed the relationship between surgical technique and surgical margins,

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perioperative Outcomes of Open, Laparoscopic, and Robotic Partial Nephrectomy: A Prospective Multicenter Observational Study (The RECORd 2 Project)

Bravi

Larcher

Capitanio

et al. 2021

European Urology Focus

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“…Furthermore, we excluded any patients who received systemic therapy as a component of initial treatment, which may erroneously Although such exclusion criteria may limit capture of perioperative or treatment-related mortality, perioperative mortality after nephrectomy or partial nephrectomy is low. 23 Finally, this study does not include cases treated in the past several years given the nature of national cancer database reporting and the lag between treatment and data collection and distribution.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Body Radiation Therapy for the Definitive Treatment of Early Stage Kidney Cancer: A Survival Comparison With Surgery, Tumor Ablation, and Observation

Grant

Lei

Hess

et al. 2020

Advances in Radiation Oncology

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Purpose: Partial nephrectomy is the preferred definitive treatment for early stage kidney cancer, with tumor ablative techniques or active surveillance reserved for patients not undergoing surgery. Stereotactic body radiation therapy (SBRT) has emerged as a potential noninvasive alternative for patients with early stage kidney cancer not amenable to surgery, with early reports suggesting excellent rates of local control and limited toxicity. Methods and Materials: The national cancer database from 2004 to 2014 was queried for patients who received a diagnosis of T1N0M0 kidney cancer. Treatments were categorized as surgery (partial or total nephrectomy), tumor ablation (cryoablation or thermal ablation), SBRT (radiation therapy in 5 fractions or less to a total biological effective dose [BED 10 ] of 72 or more), or observation. A propensity score was generated by multinomial logistic regression. A Cox proportional hazards model was fit to determine association between overall survival and treatment group with propensity score adjustments for patient, demographic, and treatment characteristics. Results: A total of 165,298 received surgery, 17,196 underwent tumor ablation, 104 underwent SBRT, and 18,241 were observed. Median follow-up was 51 months. On multivariable analysis, surgery, tumor ablation, and SBRT were associated with a decreased risk of death compared with observation, with hazard ratios of 0.25 (95% confidence interval, 0.24-0.26, P < .001), 0.36 (0.35-0.38, P < .001), and 0.56 (0.39-0.79, P < .001), respectively. When stratifying by BED 10 and compared with observation, hazard ratio for risk of death for patients treated with SBRT to a BED 10 100 (n Z 62) and a BED 10 <100 (n Z 42) was 0.34 (0.19-0.60, P < .001) and 0.90 (0.58-1.4, P Z .64), respectively. Conclusions: In this population-based cohort, patients undergoing high-dose SBRT (BED 10 100) for early stage kidney cancer demonstrated longer survival compared with patients undergoing observation. This may be a promising noninvasive treatment option for nonsurgical candidates with prospective efficacy and safety assessments meriting study in future clinical trials.

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“…Few studies assessed the morbidity of patients who underwent nephrectomy in the USA. Most of these analyzed the ACS NSQIP database that includes surgical‐specific rather than cancer‐specific variables and a detailed description of perioperative outcomes 12–14 . Only one study used the National Cancer Institute SEER including patients treated with nephrectomy from 1988 to 2004 9 …”

Section: Introductionmentioning

confidence: 99%

“…Most of these analyzed the ACS NSQIP database that includes surgical-specific rather than cancerspecific variables and a detailed description of perioperative outcomes. [12][13][14] Only one study used the National Cancer Institute SEER including patients treated with nephrectomy from 1988 to 2004. 9 We aimed to provide an update of TDM rates after PN and RN in the USA using the most recent version of the SEER database, and to develop a model predicting the risk of TDM among patients with different RCC stages.…”

Section: Introductionmentioning

confidence: 99%

Nomogram predicting 30‐day mortality after nephrectomy in the contemporary era: Results from the SEER database

et al. 2020

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Objectives To assess contemporary 30‐day mortality rates after partial and radical nephrectomy in USA, and to develop a predictive model of 30‐day mortality. Methods We relied on the National Cancer Institute Surveillance, Epidemiology and End Results database. A multivariable logistic regression analysis was fitted to predict 30‐day mortality. A nomogram was built based on the coefficients of the logit function. Internal validation was carried out using the leave‐one‐out cross‐validation. Calibration was graphically investigated. Results A total of 102 146 patients who underwent partial nephrectomy (n = 36 425; 35.7%) or radical nephrectomy (n = 65 721; 64.3%) between 2005 and 2015 were included in the analysis. The median age at diagnosis was 62 years. A total of 11 921 (11.7%) patients were African American. The clinical stage was T1–T2 in 79 452 (77.8%), T3 in 16 141 (15.8%) and T4/T1–4–M1 in 6553 (6.4%) patients. Overall, 497 deaths occurred during the initial 30 days after nephrectomy (0.49% 30‐day mortality rate). Stratified by type of surgery, the 30‐day mortality rate was 0.16% for partial nephrectomy and 0.67% for radical nephrectomy. At univariate analyses, age, tumor size, stage and surgical procedure emerged as predictors of 30‐day mortality (all P < 0.001). All of these covariates were included in the multivariable logistic regression model. The area under the curve after leave‐one‐out cross‐validation was 0.808 (95% confidence interval 0.788–0.828), and the model showed good calibration in the range of predicted probability <10%. Conclusions Contemporary rates of 30‐day mortality in patients undergoing radical or partial nephrectomy are very low. Age and tumor stage are key determinants of 30‐day mortality. We present a predictive model that provides individual probabilities of 30‐day mortality after nephrectomy, and it can be used for patient counseling prior surgery.

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Perioperative Morbidity of Open Versus Minimally Invasive Partial Nephrectomy: A Contemporary Analysis of the National Surgical Quality Improvement Program

Abstract: In this contemporary national cohort, MIPN was independently associated with reduced rates of 30-day complications, perioperative blood transfusion, prolonged hospitalization, hospital readmission, and reoperation, compared with OPN.

Cited by 27 publications

References 27 publications

Perioperative Outcomes of Open, Laparoscopic, and Robotic Partial Nephrectomy: A Prospective Multicenter Observational Study (The RECORd 2 Project)

Perioperative Outcomes of Open, Laparoscopic, and Robotic Partial Nephrectomy: A Prospective Multicenter Observational Study (The RECORd 2 Project)

Stereotactic Body Radiation Therapy for the Definitive Treatment of Early Stage Kidney Cancer: A Survival Comparison With Surgery, Tumor Ablation, and Observation

Nomogram predicting 30‐day mortality after nephrectomy in the contemporary era: Results from the SEER database

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