Evolving trends in the surgical management of renal masses over the past two decades: A contemporary picture from a large prospectively-maintained database

Int J Urol. 2019 Apr;26(4):465-474. doi: 10.1111/iju.13909. Epub 2019 Feb 28.

Abstract

Objectives: To investigate the trends in the presentation and surgical management of renal tumors at Singapore General Hospital, Singapore.

Methods: We accessed our uro-oncological registry to extract the clinicopathological data of patients with renal tumors who underwent nephrectomy from 2000 to 2015. Binary logistic regression was used to identify predictors of nephron-sparing surgery utilization, Clavien-Dindo grade ≥III complications and progression to stage ≥3 chronic kidney disease. Cox regression models were created to evaluate the proportional hazards of the risk factors for overall survival and cancer-specific survival.

Results: A total of 1208 cases of nephrectomy were carried out between 2000 and 2015. The proportion of cT1a tumors increased from 2000-2004 to 2010-2015, which was accompanied by the doubling of utilization rates of nephron-sparing surgery and minimally invasive surgery. Charlson Comorbidity Index score <2, asymptomatic presentation, clinical T1a tumors and having an estimated glomerular filtration rate ≥30 mL/min/1.73 m2 were all independent predictors of nephron-sparing surgery utilization. Age, symptomatic presentation and nephron-sparing surgery utilization were all significantly associated with greater odds of having Clavien-Dindo grade ≥III complications, whereas minimally invasive surgery was associated with decreased risk. The utilization of partial nephrectomy and minimally invasive surgery was significantly associated with a decreased risk of developing postoperative stage ≥3 chronic kidney disease. Both overall survival and cancer-specific survival were not significantly affected by whether nephron-sparing surgery was utilized.

Conclusions: There has been an increasing proportion of small renal masses diagnosed incidentally with a shift towards nephron-sparing surgery for clinically localized tumors. With the adoption of nephron-sparing surgery, progression to stage 3 chronic kidney disease has decreased, without any compromise in oncological and survival outcomes.

Keywords: clinical outcomes; minimally invasive surgery; nephron-sparing surgery; partial nephrectomy; renal cancer.

MeSH terms

  • Aged
  • Databases, Factual / statistics & numerical data
  • Disease Progression
  • Female
  • Glomerular Filtration Rate
  • Hospitals, General / statistics & numerical data
  • Hospitals, General / trends
  • Humans
  • Kaplan-Meier Estimate
  • Kidney Neoplasms / mortality
  • Kidney Neoplasms / pathology
  • Kidney Neoplasms / surgery*
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / adverse effects
  • Minimally Invasive Surgical Procedures / statistics & numerical data
  • Minimally Invasive Surgical Procedures / trends*
  • Neoplasm Staging
  • Nephrectomy / adverse effects
  • Nephrectomy / methods
  • Nephrectomy / statistics & numerical data
  • Nephrectomy / trends*
  • Nephrons / pathology
  • Nephrons / surgery
  • Organ Sparing Treatments / adverse effects
  • Organ Sparing Treatments / methods
  • Organ Sparing Treatments / statistics & numerical data
  • Organ Sparing Treatments / trends*
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Practice Patterns, Physicians' / statistics & numerical data
  • Practice Patterns, Physicians' / trends
  • Prospective Studies
  • Registries / statistics & numerical data
  • Renal Insufficiency, Chronic / epidemiology*
  • Renal Insufficiency, Chronic / etiology
  • Renal Insufficiency, Chronic / prevention & control
  • Singapore / epidemiology
  • Time Factors
  • Treatment Outcome