Controversies of partial nephrectomy for renal cell carcinoma : survey in the German-speaking countries

• Published in: Urologe. Ausgabe A 2014-08, Vol.53 (8), p.1181-1185
• Main Authors: Tietze, S, Herms, M, Behrendt, W, Krause, J, Hamza, A
• Format: Article
• Language: ger
• Subjects: Austria; Carcinoma, Renal Cell - epidemiology; Carcinoma, Renal Cell - surgery; Catchment Area (Health) - statistics & numerical data; Germany - epidemiology; Health Care Surveys; Humans; Kidney Neoplasms - epidemiology; Kidney Neoplasms - surgery; Laparoscopy - utilization; Minimally Invasive Surgical Procedures - utilization; Nephrectomy - utilization; Organ Sparing Treatments - utilization; Practice Patterns, Physicians' - statistics & numerical data; Prevalence; Switzerland - epidemiology; Treatment Outcome
• ISSN: 1433-0563
• DOI: 10.1007/s00120-014-3469-5

The goal of this study was to evaluate how partial nephrectomy is technically performed in Germany, Austria, and Switzerland. A one-page anonymous questionnaire was designed to evaluate the indication, the technical procedure, and the follow-up of R1 situation after partial nephrectomy. Furthermore, the size of the hospitals and their catchment areas were recorded. The questionnaire was sent to 341 clinics and a statistical analysis was performed. The response rate was 69 %. Up to 99 % of the clinics also perform partial resection in T1b tumors. Of those responding, 58 % perform this surgery laparoscopically, and 83 % of the surgeries are performed in warm ischemia. For the follow-up, 29 % suggest imaging within the first 6 weeks. According to this survey, maximum care clinics perform laparoscopic nephrectomy more frequently (p = 0.003). The survey of 236 hospitals performing partial nephrectomy shows great variability in the indication, technique, and aftercare of organ-preserving renal tumor surgery. It also shows that a large proportion of tumors >4 cm undergo organ-preserving surgery, many of them minimally invasive. The diverse handling with positive instantaneous section and R1 results suggest the need for further studies concerning long-term follow-up after minimally invasive surgery with R1 situation and renal tumors > T1a.