Evolving trends in the surgical management of renal masses over the past two decades: A contemporary picture from a large prospectively‐maintained database. (28th February 2019)

• Record Type: Journal Article
• Authors: Chen, Kenneth; Lee, Alvin; Huang, Hong Hong; Tay, Kae Jack; Sim, Allen; Lee, Lui Shiong; Cheng, Christopher Wai Sam; Ng, Lay Guat; Ho, Henry Sun Sien; Yuen, John Shyi Peng
• Is Part Of: International journal of urology. Volume 26:Number 4(2019)
• Page Start: 465
• Page End: 474
• Publication Date: 2019-02-28
• Subjects: clinical outcomes -- minimally invasive surgery -- nephron‐sparing surgery -- partial nephrectomy -- renal cancer; Urology -- Periodicals; Genitourinary organs -- Periodicals; Urologic Diseases -- Periodicals; 616.6005
• DOI: 10.1111/iju.13909
• Languages: English
• ISSNs: 0919-8172

Abstract

Abstract : Objectives: To investigate the trends in the presentation and surgical management of renal tumors at Singapore General Hospital, Singapore. Methods: We accessed our uro‐oncological registry to extract the clinicopathological data of patients with renal tumors who underwent nephrectomy from 2000 to 2015. Binary logistic regression was used to identify predictors of nephron‐sparing surgery utilization, Clavien–Dindo grade ≥III complications and progression to stage ≥3 chronic kidney disease. Cox regression models were created to evaluate the proportional hazards of the risk factors for overall survival and cancer‐specific survival. Results: A total of 1208 cases of nephrectomy were carried out between 2000 and 2015. The proportion of cT1a tumors increased from 2000–2004 to 2010–2015, which was accompanied by the doubling of utilization rates of nephron‐sparing surgery and minimally invasive surgery. Charlson Comorbidity Index score <2, asymptomatic presentation, clinical T1a tumors and having an estimated glomerular filtration rate ≥30 mL/min/1.73 m 2 were all independent predictors of nephron‐sparing surgery utilization. Age, symptomatic presentation and nephron‐sparing surgery utilization were all significantly associated with greater odds of having Clavien–Dindo grade ≥III complications, whereas minimally invasive surgery was associated with decreased risk. The utilization of partial nephrectomy and minimally invasive surgery was significantly associated with a decreased risk of developing postoperative stage ≥3 chronic kidney disease. Both overall survival and cancer‐specific survival were not significantly affected by whether nephron‐sparing surgery was utilized. Conclusions: There has been an increasing proportion of small renal masses diagnosed incidentally with a shift towards nephron‐sparing surgery for clinically localized tumors. With the adoption of nephron‐sparing surgery, progression to stage 3 chronic kidney disease has decreased, without any compromise in oncological and survival outcomes.