Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan 48109-2800, USA.
Cancer. 2011 Sep 15;117(18):4184-93. doi: 10.1002/cncr.26014. Epub 2011 Mar 1.
Because there is limited population-based evidence supporting the comparative effectiveness of laparoscopic radical nephrectomy (LRN) after its widespread adoption, we compared trends in hospital-based outcomes among patients with kidney cancer treated with LRN or open radical nephrectomy (ORN).
Using linked SEER-Medicare data, the authors identified patients with kidney cancer who were treated with LRN or ORN from 2000 through 2005. The authors measured 4 primary outcomes: intensive care unit (ICU) admission, prolonged length of stay, 30-day hospital readmission, and in-hospital mortality. The authors then estimated the association between surgical approach and each outcome, adjusting for patient demographics, tumor characteristics, and year of surgery.
The authors identified 2108 (26%) and 5895 (74%) patients treated with LRN and ORN, respectively. Patients treated with LRN were more likely to be white, female, of higher socioeconomic position, and to have tumor sizes of ≤4 cm (all P < .05). The adjusted probability of ICU admission and prolonged length of stay was 41% and 46% lower, respectively, for patients undergoing LRN (P < .001). Although uncommon for both groups, the adjusted probability of in-hospital mortality was 51% higher (2.3% vs 1.5%, P = .04) for patients treated with a laparoscopic approach.
At a population level, patients treated with LRN have a lower likelihood of ICU admission and prolonged length of stay, supporting the convalescence benefits of laparoscopy. In-hospital mortality, however, was higher among patients treated with LRN. The latter finding suggests a potentially unanticipated consequence of this technique and highlights the need for long-term monitoring during and after the widespread adoption of new surgical technologies.
由于腹腔镜根治性肾切除术（LRN）广泛应用后，支持其比较有效性的基于人群的证据有限，我们比较了接受 LRN 或开放性根治性肾切除术（ORN）治疗的肾癌患者的医院结局趋势。
作者使用链接的 SEER-Medicare 数据，确定了 2000 年至 2005 年期间接受 LRN 或 ORN 治疗的肾癌患者。作者测量了 4 个主要结局：重症监护病房（ICU）入院、延长住院时间、30 天医院再入院和院内死亡率。然后，作者根据患者人口统计学特征、肿瘤特征和手术年份，估计手术方法与每种结局的关联。
作者分别确定了 2108（26%）和 5895（74%）例接受 LRN 和 ORN 治疗的患者。接受 LRN 治疗的患者更可能是白人、女性、社会经济地位较高，肿瘤大小≤4cm（均 P<0.05）。接受 LRN 治疗的患者 ICU 入院和延长住院时间的调整后概率分别降低了 41%和 46%（均 P<0.001）。尽管两组均不太常见，但接受腹腔镜治疗的患者的院内死亡率调整后增加了 51%（2.3%比 1.5%，P=0.04）。
在人群水平上，接受 LRN 治疗的患者 ICU 入院和延长住院时间的可能性较低，支持腹腔镜的康复益处。然而，接受 LRN 治疗的患者的院内死亡率更高。后一种发现提示了该技术可能出现的意外后果，并强调了在新手术技术广泛应用期间和之后进行长期监测的必要性。
