Time trends in service provision and survival outcomes for patients with renal cancer treated by nephrectomy in England 2000-2010.


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Authors
Barclay, Matthew 
Loughran, Molly A 
Lyratzopoulos, Georgios 
Gnanapragasam, Vincent J 
Abstract

OBJECTIVE: To describe the temporal trends in nephrectomy practice and outcomes for English patients with renal cell carcinoma (RCC). PATIENTS AND METHODS: Adult RCC nephrectomy patients treated between 2000 and 2010 were identified in the National Cancer Data Repository and Hospital Episode Statistics, and followed-up until date of death or 31 December 2015 (n = 30 763). We estimated the annual frequency for each nephrectomy type, the hospital and surgeon numbers and their case volumes. We analysed short-term surgical outcomes, as well as 1- and 5-year relative survivals. RESULTS: Annual RCC nephrectomy number increased by 66% during the study period. Hospital number decreased by 24%, whilst the median annual hospital volume increased from 10 to 23 (P < 0.01). Surgeon number increased by 27% (P < 0.01), doubling the median consultant number per hospital. The proportion of minimally invasive surgery (MIS) nephrectomies rose from 1% to 46%, whilst the proportion of nephron-sparing surgeries (NSS) increased from 5% to 16%, with 29% of all T1 disease treated with partial nephrectomy in 2010 (P < 0.01). The 30-day mortality rate halved from 2.4% to 1.1% and 90-day mortality decreased from 4.9% to 2.6% (P < 0.01). The 1-year relative survival rate increased from 86.9% to 93.4%, whilst the 5-year relative survival rate rose from 68.2% to 81.2% (P < 0.01). Improvements were most notable in patients aged ≥65 years and those with T3 and T4 disease. CONCLUSIONS: Surgical RCC management has changed considerably with nephrectomy centralisation and increased NSS and MIS. In parallel, we observed significant improvements in short- and long-term survival particularly for elderly patients and those with locally advanced disease.

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Keywords
#KidneyCancer, centralisation, nephrectomy, postoperative outcomes, renal cancer, survival, Aged, Delivery of Health Care, England, Female, Humans, Kidney Neoplasms, Male, Middle Aged, Nephrectomy, Nephrons, Organ Sparing Treatments, Practice Patterns, Physicians', Retrospective Studies, Survival Analysis, Time Factors, Treatment Outcome
Journal Title
BJU Int
Conference Name
Journal ISSN
0022-5347
1464-410X
Volume Title
122
Publisher
Wiley
Sponsorship
Urology Foundation (Research Scholarship Applicati)
Addenbrooke's Charitable Trust (ACT) (241/15 A/Hsu)