To assess European Association of Urology (EAU) guideline adherence on the surgical management of patients with T1 renal tumours and the effects of centralization of care.
Retrospective data from all kidney tumours that underwent radical nephrectomy (RN) or PN in the period 2012-2016 from the BAUS nephrectomy audit were retrieved and analysed. We assessed total surgical hospital volume (HV; RN and PN performed) per center, PN rates; complication rates, and completeness of data. Descriptive analyses were performed and confidence intervals was used to illustrate the association between hospital volume and proportion of PN. Chi2 and Cochran-Armitage trend tests were used to evaluate differences and trends.
In total, 13045 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 PADUA complexity score was included in March 2016 and documented in 39% of cases. Missing information on post-operative 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 ≥3) 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.
Closer guideline adherence was exhibited by higher surgical volume centers. 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 centralization of kidney cancer specialist cancer surgical services to improve patient outcomes. This article is protected by copyright. All rights reserved.
BJU international. 2019 Jul 11 [Epub ahead of print]
Mgb Tran, K Aben, E Werkhoven, J B Neves, S Fowler, M Sullivan, G D Stewart, B Challacombe, A Mahrous, P Patki, F Mumtaz, R Barod, A Bex, British Association of Urological Surgeons
Division of Surgery and Interventional Science, University College London, London, United Kingdom., Netherlands Comprehensive Cancer Centre, Utrecht, Netherlands., Netherlands Cancer Institute, Amsterdam, Netherlands., British Association of Urological Surgeons, United Kingdom., Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom87Cambridge University Hospitals NHS Foundation Trust, CambridgeUnited Kingdom., Department of Surgery, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom., Guy’s and St Thomas’ NHS Foundation Trust, London, UK., Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, United Kingdom.