Nephron-sparing surgery across a nation - outcomes from the British Association of Urological Surgeons 2012 national partial nephrectomy audit

Archie Fernando; Sarah Fowler; Tim O'Brien; British Association of Urological Surgeons (BAUS)

doi:10.1111/bju.13353

Nephron-sparing surgery across a nation - outcomes from the British Association of Urological Surgeons 2012 national partial nephrectomy audit

BJU Int. 2016 Jun;117(6):874-82. doi: 10.1111/bju.13353. Epub 2015 Nov 18.

Authors

Archie Fernando^{1

2}, Sarah Fowler¹, Tim O'Brien^{1

2}; British Association of Urological Surgeons (BAUS)

Collaborators

British Association of Urological Surgeons (BAUS):
Z Abbasi, A S Adamson, S K Addla, A A Adeyoju, J M Adshead, N Afzal, T F Aho, M Akhtar, M Al-Akraa, M Al-Sudani, J Allan, D J Almond, C J Anderson, S J Andrews, I Apakama, T Armitage, J Armitage, N Awsare, B Ayres, G K Banerjee, N J Barber, J M Barua, S Basu, A S Bdesha, C J M Beacock, J Beatty, R O Beck, M Belal, C R W Bell, S M Bhanot, R Bhatt, C S Biyani, R A Blades, C Blake, B Blake-James, J Boddy, S J Bromage, E Bromwich, C Brown, A J Browning, N P Bryan, N A Burgess, N Burns-Cox, P C Butterworth, J Bycroft, J G Calleary, R C Calvert, I Campbell, C A Campbell, A Cannon, P G Carter, C J M Carter, J J Cartledge, R Casey, A Chakravarti, B Challacombe, S Chandrasekharan, B G Chappell, T F Chen, J Cherian, W H Choi, K Chow, J Clavijo Eisele, A M Cliff, N P Cohen, O J Cole, J Collins, S Connolly, P W Cooke, G Cooksey, A J Cornaby, P A Cornford, J G Corr, R Coulthard, D W Cranston, J Cresswell, M C Crundwell, P E Cutinha, M Cynk, P D Daruwala, P Dasgupta, S N Datta, K Davenport, A R de Bolla, R Devarajan, D A G Dickerson, A J Dickinson, A P Doherty, P J Donaldson, T Dudderidge, J Dyer, J Eaton, B Eddy, C G Eden, M Elsaghir, S D Evans, R Fiala, M V P Fordham, M C Foster, A J French, R J Frymann, Z J Gall, C R R Gallegos, H B Y Gana, S Garnett, M Ghei, N Gibbons, H W Gilbert, D A Gillatt, H C Godbole, A Golash, C M Goodman, B Gowardhan, J S A Green, T R L Griffiths, S Gujral, T Gunendran, C M Hagan, N Haldar, D C Hanbury, J Harney, S T Hasan, S J Hawkyard, M C Hayes, M D Haynes, A Henderson, J A Hicks, R G Hindley, D J Hodgson, M Hotston, G P Howell, D Hrouda, O D M Hughes, P Hunter-Campbell, C Ilie, R Issa, S Jain, A Jain, K S Janjua, P Javle, P Johnson, M I Johnson, A Jones, H Joshi, A D Joyce, S Kanaga-Sundaram, O M A Karim, F X Keeley, A Kelkar, J P Kelleher, A Q Khattak, B Khoubehi, M Kimuli, M M Kirollos, R C Kockelbergh, G Kooiman, A Koupparis, P Kumar, H G Kynaston, M E Laniado, T Larner, Z Latif, M W Lau, P J le Roux, S Leung, J Leveckis, G Lewis, T G Liston, C R W Lockyer, R N Lodge, C J Luscombe, M Lynch, C Lynch, N N K Lynn, J P MacDermott, S Mackie, S Madaan, S B Maddineni, P Maheshkumar, A A Makar, J T Makunde, R Manikandan, G S Mann, M Mantle, I R Mark, S S Matanhelia, J McCabe, S McClinton, J P McFarlane, P D McInerney, I G McIntyre, E McLarty, M E McLornan, J McLoughlin, S A McNeill, S Mehta, J K Mellon, P Menezes, R D Mills, M Mokete, R Montague, A L Morton, H G Motiwala, C K Mulholland, F H Mumtaz, N Munro, A Myatt, M Nair, S Namasivayam, R D Napier-Hemy, S Nathan, D Neilson, D L Nicol, M Nuttall, H F O'Kane, A O'Riordan, G Oades, N Oakley, A A Okeke, J Olsburgh, E Paez, T Page, J Parkin, B T Parys, P Patel, N Patel, B Patel, S Pathak, K Patil, A B Paul, D Payne, A M Peracha, J L Peters, S M A Phillips, J T Phillips, S Phipps, M K Pillai, J M Potter, S Prescott, T N Rajan, P Rajjayabun, V A C Ramani, A Rane, R Ravi, S Ravichandran, P J M Richmond, A C P Riddick, P D Rimington, G H Rix, D Rix, L Q Robinson, M Rochester, K M Rogawski, E Rowe, K Sahadevan, A Samsudin, S Sandhu, V K Sangar, H Sells, D C Shackley, Z Shah, N N A Shaikh, H Sharma, B Sherwood, S Singh, G Singh, D J Smith, L Solomon, N A Soomro, V Srinivasan, S I Sriprasad, R N Stephenson, A Stewart, S R Stubington, K Subramonian, M E Sullivan, S Taneja, R Thilagarajah, S A Thomas, D J Thomas, B Thomas, A C Thompson, A V Thurston, K J Turner, O N Umez-Eronini, S M Upsdell, J A Vale, H Varadaraj, S G Vesey, R Viney, T Walton, H E Warburton, B Waymont, J J Webster, G M Webster, A Wedderburn, G D Wemyss-Holden, R Weston, T Whittlestone, S Wilkinson, B Wilkinson, S Williams, M I Wills, J R Wilson, I D Wilson, C R J Woodhouse, M Wright, D R Yates, J G Young

Affiliations

¹ BAUS, The Royal College of Surgeons of England, London, UK.
² The Urology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.

PMID: 26469291
DOI: 10.1111/bju.13353

Abstract

Objective: To determine the scope and outcomes of nephron-sparing surgery (NSS), i.e. partial nephrectomy, across the UK and in so doing set a realistic benchmark and identify fresh contemporary challenges in NSS.

Patients and methods: In 2012 reporting of outcomes of all types of nephrectomy became mandatory in the UK. In all, 148 surgeons in 86 centres prospectively entered data on 6 042 nephrectomies undertaken in 2012. This study is a retrospective analysis of the NSS procedures in the dataset.

Results: A total of 1 044 NSS procedures were recorded and the median (range) surgical volume was 4 (1-39) per consultant and 8 (1-59) per centre. In all, 36 surgeons and 10 centres reported on only one NSS. The indications for NSS were: elective with a tumour of ≤4.5 cm in 59%, elective with a tumour of >4.5 cm in 10%, relative in 7%, imperative in 12%, Von Hippel-Lindau in 1%, and unknown in 11%. The median (range) tumour size was 3.4 (0.8-30) cm. The technique used was minimally invasive surgery in 42%, open in 58%, with conversions in 4%. The histology results were: malignant in 80%, benign in 18%, and unknown in 2%. In patients aged <40 years 36% (36/101) had benign histology vs 17% (151/874) of those aged ≥40 years (P < 0.01). In patients with tumours of <2.5 cm 29% (69/238) had benign histology vs 14% (57/410) with tumours of 2.5-4 cm vs 8% (16/194) with tumours of ≥4 cm (P = 0.02). In patients aged <40 years with of tumours of <2.5 cm 44% (15/34) were benign. The 30-day mortality was 0.1% (1/1 044). There were major complications (Clavien-Dindo grade of ≥IIIa) in 5% (53/1 044). There was an increased risk of complications after extended elective NSS of 19% (19/101) vs elective at 12% (76/621) (relative risk [RR] 1.54; P < 0.01). Margins were recorded in 68% (709/1 044) of the patients, with positive margins identified in 7% (51/709). Positive surgical margins after NSS for pathological T3 (pT3) tumours were found in 47.8% (11/23) vs 6.1% (32/523) for pT1a, tumours (RR 5.61; P < 0.01). In all, 14% (894/6 042) of the patients underwent surgery for T1a tumours: 55% (488/894) by NSS, 42% (377/894) by radical nephrectomy (RN), and in 3% (29/894) the procedure used was unknown. Major complications after occurred in 4.9% (24/488) of NSS vs 1.3% (5/377) of RN (P < 0.01). Limitations included poor reporting of renal function data and no data on tumour complexity.

Conclusions: In its first year, mandatory national reporting has provided several challenging contemporary insights into NSS.

Keywords: complications; national audit; nephron‐sparing surgery; partial nephrectomy; renal cancer.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Carcinoma, Renal Cell / pathology
Carcinoma, Renal Cell / surgery*
Clinical Audit*
Elective Surgical Procedures
Female
Humans
Kidney Neoplasms / pathology
Kidney Neoplasms / surgery*
Male
Middle Aged
Neoplasm Recurrence, Local / pathology
Nephrectomy* / methods
Nephrons / pathology
Nephrons / surgery*
Organ Sparing Treatments* / methods
Retrospective Studies
Treatment Outcome
United Kingdom / epidemiology
Young Adult