The Adoption of Nephron-Sparing Surgery in Europe - A Trend Analysis in Two Referral Centers from Austria and Germany

OBJECTIVE: To compare the trends of partial nephrectomy (PN) and radical nephrectomy (RN) in 2 European tertiary referral centers with regards to guideline changes.

MATERIALS AND METHODS: A total of 1,573 patients who underwent RN or PN for localized (≤T2) renal cell carcinoma (RCC) were included. Logistic regression analyses assessed the predictors of PN and laparoscopy over time.

RESULTS: Out of the total, 1,013 patients (65.6%) were treated with RN and 560 patients (34.4%) with PN. Also, 1,233 patients (80%) had open surgery whereas 340 patients (22%) were treated with a laparoscopic approach. Laparoscopic RN and PN were performed in 216 (13.7%) and 124 (7.8%) patients, respectively. T1b tumors were 73% less likely (p < 0.001) to be treated with PN compared to T1a tumors. The odds of undergoing PN or laparoscopy in 2008-2010 relative to 2000-2001 were 6.5-fold (p < 0.001) and 36-fold higher (p < 0.001), respectively.

CONCLUSIONS: Tumor size and year of surgery are independent predictors of PN in our cohort. Our data exemplify the adoption of PN for RCC in tertiary care centers in Austria and Germany in line with implemented guideline changes. The utilization of PN has increased over time regardless of surgical approach. Further studies need to address the use of robot-assisted surgery and care in community hospitals.