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

• Published in: Cancer 2011-09, Vol.117 (18), p.4184-4193
• Main Authors: Tan, Hung‐Jui, Wolf, J. Stuart, Ye, Zaojun, Wei, John T., Miller, David C.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Female; Hospital Mortality; Humans; intensive care; kidney neoplasm; Kidney Neoplasms - surgery; Kidneys; Laparoscopy; length of stay; Male; Medical sciences; Nephrectomy - methods; Nephrology. Urinary tract diseases; patient readmission; Treatment Outcome; Tumors; Tumors of the urinary system
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.26014

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 = .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;. © 2011 American Cancer Society. Patients with kidney cancer treated with laparoscopic radical nephrectomy (LRN) were less likely to require intensive care or prolonged length of stay when compared with those treated with an open approach, supporting the convalescence benefits of laparoscopy. However, in‐hospital mortality was greater for patients treated with LRN, suggesting a potentially unanticipated consequence of this technique and highlighting the need for long‐term monitoring both during and after the widespread adoption of innovative surgical therapies.