Population‐level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer

Abstract

BACKGROUND:Because there is limited population-based evidence supporting the comparative effectiveness of laparoscopic radical nephrectomy (LRN) after its widespread adoption, we compared trends in hospital-based outcomes among patients with kidney cancer treated with LRN or open radical nephrectomy (ORN). METHODS: Using linked SEER-Medicare data, the authors identified patients with kidney cancer who were treated with LRN or ORN from 2000 through 2005. The authors measured 4 primary outcomes: intensive care unit (ICU) admission, prolonged length of stay, 30-day hospital readmission, and in-hospital mortality. The authors then estimated the association between surgical approach and each outcome, adjusting for patient demographics, tumor characteristics, and year of surgery. RESULTS: The authors identified 2108 (26%) and 5895 (74%) patients treated with LRN and ORN, respectively. Patients treated with LRN were more likely to be white, female, of higher socioeconomic position, and to have tumor sizes of 4 cm (all P < .05). The adjusted probability of ICU admission and prolonged length of stay was 41% and 46% lower, respectively, for patients undergoing LRN (P < .001). Although uncommon for both groups, the adjusted probability of in-hospital mortality was 51% higher (2.3% vs 1.5%, P ¼ .04) for patients treated with a laparoscopic approach. CONCLUSIONS: At a population level, patients treated with LRN have a lower likelihood of ICU admission and prolonged length of stay, supporting the convalescence benefits of laparoscopy. In-hospital mortality, however, was higher among patients treated with LRN. The latter finding suggests a potentially unanticipated consequence of this technique and highlights the need for long-term monitoring during and after the widespread adoption of new surgical technologies. Cancer 2011;117:4184-93.

Renal surgery for kidney cancer in Germany 2005–2006: length of stay, risk of postoperative complications and in-hospital death

“…It presents virtually a nationwide, unbiased overview of all types of tumor nephrectomies undertaken in Germany and provides the most comprehensive and contemporary analysis of the use of nephrectomy for renal cancer treatment. Furthermore, we used all available comorbidity diagnoses (up to 100 ICD-10 codes) whereas previous studies used 3 [30], 6 [15], 15 [8], or up to 20 [7] diagnoses only to derive Charlson comorbidity index and complications.…”

Rates of open versus laparoscopic and partial versus radical nephrectomy for T1a renal cell carcinoma: A population‐based evaluation

“…Predominantly, several important disease characteristics, such as those defined by the RENAL (radius, exophytic/endophytic properties, nearness of tumor to the collecting system or sinus in millimeters, anterior/posterior, location relative to polar lines) nephrometry score as initially proposed by the Fox Chase Cancer Center, are not available within the SEER Medicare database. That being said, large observational population‐based cohorts are often limited by the lack of detailed tumor characteristics, but remain widely used . Second, information on hospital and surgeon identification was not available for all identified patients.…”

“…For example, in an observational study, the proportion of hospitals carrying out at least one laparoscopic nephrectomy per year increased from 4% to 26% from 1989 to 2003 . Given the increasing popularity of nephrectomies carried out by the laparoscopic approach, contemporary studies have reported that laparoscopic nephrectomy affords equal postoperative and functional outcomes, and equivalent cancer control outcomes relative to open nephrectomy …”

Effects of Open versus Laparoscopic Nephrectomy Techniques on Oxidative Stress Markers in Patients with Renal Cell Carcinoma

“…Although it is technically demanding, laparoscopy provides RCC patients improved quality of life during recovery period with decreased analgetic requirements, fewer complications, and more rapid convalescence [24, 25]. However, there are some reports about higher in-hospital mortality and more common failure to rescue after laparoscopy probably due to poor experience of surgeons and hospitals [24, 25]. Despite all the advantages, laparoscopic surgery can have several local and systemic consequences related to the induction of pneumoperitoneum used to facilitate the visual field.…”