Real-world outcomes of patients with renal cell carcinoma, surgically treated at regional hospitals, based on a prospective long-term survey of the pre-robotic era
-
Published:2023-02-13
Issue:
Volume:
Page:
-
ISSN:1573-2584
-
Container-title:International Urology and Nephrology
-
language:en
-
Short-container-title:Int Urol Nephrol
Author:
Kawasaki YoshihideORCID, Saito Hideo, Ioritani Naomasa, Tochigi Tatsuo, Numata Isamu, Numahata Kenji, Soma Fumihiko, Kyan Atsushi, Ishidoya Shigeto, Ota Shozo, Namima Takashige, Orikasa Kazuhiko, Yamashita Shinichi, Mitsuzuka Koji, Arai Yoichi, Ito Akihiro
Abstract
Abstract
Purpose
Renal cancer surgery is frequently performed in small regional hospitals in Japan. This study evaluated the outcomes of renal cancer surgery, comparing results from the pre-robotic surgery era with those obtained with robotic surgery.
Methods
This prospective cohort study was conducted on patients who underwent renal cancer surgery between 2008 and 2013 at 14 hospitals, comprising 13 regional hospitals and a university hospital, registered in the Tohoku Urological Evidence-Based Medicine Study Group. The patients’ backgrounds; perioperative data; annual postoperative renal function; and prognostic surveys, performed over a median follow-up period of 10 years were obtained.
Results
In 930 surgical cases at the 14 registered hospitals, the 10-year recurrence-free survival rates of cT1a, cT1b, cT2, and cT3 were 0.9326, 0.8501, 0.5786, and 0.5101, respectively. Meanwhile, the 10-year overall survival rates were 0.9612, 0.8662, 0.7505, and 0.7209, respectively. Long-term observation in patients with cT1 showed that vessel involvement and high tumor grade were prognostic factors for recurrence. As a noteworthy fact, radical nephrectomy was performed in 53.3% of patients with cT1a at the regional hospitals. However, even in patients with preoperative chronic kidney disease stage 3, radical nephrectomy was not a prognostic factor of renal function. This indicates that compensatory mechanisms had been working for a long time in many patients who underwent radical nephrectomies without hypertension and preoperative proteinuria, which were predictors of end-stage renal disease.
Conclusion
Based on a prospective long-term survey of the pre-robotic era, our results suggested no difference of the survival outcomes between the university hospital and regional hospitals. Our study provides baseline data to evaluate the outcomes of renal cancer robotic surgery, performed at regional hospitals.
Funder
Grants-in-Aid for Scientific Research from the Japanese Ministry of Education, Culture, Sports, Science and Technology
Publisher
Springer Science and Business Media LLC
Subject
Urology,Nephrology
Reference13 articles.
1. Satasivam P, O’Neill S, Sivarajah G, Sliwinski A, Kaiser C, Niall O, Goad J, Brennan J (2014) The dilemma of distance: patients with kidney cancer from regional Australia present at a more advanced stage. BJU Int 113(Suppl 2):57–63. https://doi.org/10.1111/bju.12459 2. Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Colombel M, Klotz L, Skinner E, Keane T, Marreaud S, Collette S, Sylvester R (2011) A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 59(4):543–552. https://doi.org/10.1016/j.eururo.2010.12.013 3. Hjelle KM, Johannesen TB, Beisland C (2017) Postoperative 30-day mortality rates for kidney cancer are dependent on hospital surgical volume: results from a Norwegian population-based study. Eur Urol Focus 3(2–3):300–307. https://doi.org/10.1016/j.euf.2016.10.001 4. Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang A, Clark PE, Davis BJ, Derweesh IH, Giambarresi L, Gervais DA, Hu SL, Lane BR, Leibovich BC, Pierorazio PM (2017) Renal mass and localized renal cancer: AUA guideline. J Urol 198(3):520–529. https://doi.org/10.1016/j.juro.2017.04.100 5. Gershman B, Thompson RH, Boorjian SA, Lohse CM, Costello BA, Cheville JC, Leibovich BC (2018) Radical versus partial nephrectomy for cT1 renal cell carcinoma. Eur Urol 74(6):825–832. https://doi.org/10.1016/j.eururo.2018.08.028
|
|