Miller David C, Taub David A, Dunn Rodney L, Wei John T, Hollenbeck Brent K
Michigan Urology Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0330, USA.
J Urol. 2006 Sep;176(3):1102-6; discussion 1106-7. doi: 10.1016/j.juro.2006.04.101.
Recognizing the emergence of laparoscopy as a standard of care for surgical treatment in many patients with organ confined renal cell carcinoma, we explored the diffusion of this technology by examining temporal trends in the nationwide use of laparoscopic total and partial nephrectomy in patients with renal cell carcinoma.
Data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample were abstracted for 1991 through 2003. International Classification of Diseases-Ninth Revision, Clinical Modification 9 codes were used to identify patients undergoing open and laparoscopic total and partial nephrectomy for renal cell carcinoma. Using hospital sampling weights we calculated annual incidence rates for open and laparoscopic nephrectomy, thereby estimating the diffusion of laparoscopy. Bivariate and multivariate analyses were used to identify patient and hospital characteristics associated with the more frequent use of laparoscopic techniques.
Data on 63,812 patients were abstracted from the Nationwide Inpatient Sample, yielding a weighted national estimate of 323,979 who underwent laparoscopic (4.9%) or open (95.1%) nephrectomy (total or partial) for renal cell carcinoma between 1991 and 2003. Although it is still infrequent, the use of laparoscopy has increased steadily since 1998 with a utilization peak in 2003 of 1.7 laparoscopic nephrectomies per 100,000 American population, representing 16% of all total and partial nephrectomies for renal cell carcinoma in 2003. Treatment year, overall hospital nephrectomy volume and teaching hospital status were the most robust determinants of increased laparoscopic use (each p <0.001).
Although its use has increased progressively in the last decade, the dissemination of laparoscopy for renal cell carcinoma has been generally slow and limited in scope. The next step in this body of work is to identify specific technical, educational and policy interventions that will influence the diffusion of this alternative standard of care.
鉴于腹腔镜检查已成为许多局限性肾细胞癌患者外科治疗的标准治疗方法，我们通过研究全国范围内腹腔镜根治性肾切除术和部分肾切除术在肾细胞癌患者中的应用时间趋势，来探讨这项技术的普及情况。
提取1991年至2003年医疗费用与使用项目全国住院患者样本的数据。使用国际疾病分类第九版临床修订本9编码来识别接受开放性和腹腔镜根治性肾切除术及部分肾切除术治疗肾细胞癌的患者。利用医院抽样权重计算开放性和腹腔镜肾切除术的年发病率，从而估计腹腔镜检查的普及情况。采用双变量和多变量分析来确定与更频繁使用腹腔镜技术相关的患者和医院特征。
从全国住院患者样本中提取了63812例患者的数据，得出全国加权估计数为323979例，这些患者在1991年至2003年间接受了腹腔镜（4.9%）或开放性（95.1%）肾切除术（根治性或部分性）治疗肾细胞癌。虽然腹腔镜检查的使用仍然不常见，但自1998年以来其使用量稳步增加，2003年达到峰值，每10万美国人口中有1.7例腹腔镜肾切除术，占2003年所有肾细胞癌根治性和部分性肾切除术的16%。治疗年份、医院总体肾切除量和教学医院地位是腹腔镜使用增加的最有力决定因素（均p<0.001）。
尽管在过去十年中腹腔镜检查的使用逐渐增加，但肾细胞癌腹腔镜检查的普及总体上较为缓慢且范围有限。这项工作的下一步是确定具体的技术、教育和政策干预措施，以影响这种替代标准治疗方法的普及。
