Hsu, RCJ;
Barclay, M;
Loughran, MA;
Lyratzopoulos, G;
Gnanapragasam, VJ;
Armitage, JN;
(2018)
Time trends in service provision and survival outcomes for patients with renal cancer treated by nephrectomy in England 2000–2010.
BJU International
, 122
(4)
pp. 599-609.
10.1111/bju.14217.
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Abstract
OBJECTIVE: To describe the temporal trends in nephrectomy practice and outcomes for English renal cell carcinoma (RCC) patients. PATIENTS & METHODS: Adult RCC nephrectomy patients treated between 2000 and 2010 were identified in the National Cancer Data Repository (NCDR) and Hospital Episode Statistics (HES) and followed up for death through 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% while 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. Proportion of minimally-invasive nephrectomy rose from 1% to 46%, while the proportion of nephron-sparing surgery increased from 5% to 16%, with 29% of all T1 disease treated with partial nephrectomy in 2010 (p<0.01). 30-day mortality halved from 2.4% to 1.1% and 90-day mortality decreased from 4.9% to 2.6% (p<0.01). 1-year relative survival increased from 86.9% to 93.4% while 5-year relative survival rose from 68.2% to 81.2% (p<0.01). Improvements were most notable in patients 65 years and over and those with T3 and T4 disease. CONCLUSIONS: Surgical RCC management has changed considerably with nephrectomy centralisation and increased nephron-sparing and minimally-invasive surgeries. In parallel, we observed significant improvements in short-term and long-term survival particularly for elderly patients and those with locally advanced disease. This article is protected by copyright. All rights reserved.
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