Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
J Urol. 2012 Nov;188(5):1695-700. doi: 10.1016/j.juro.2012.07.029. Epub 2012 Sep 19.
Despite the high morbidity of repeat renal surgery in patients with multifocal recurrent renal carcinoma, in most patients adequate renal function is preserved to obviate the need for dialysis. To our knowledge the economic burden of repeat renal surgery has not been evaluated. We provide a cost analysis for patients requiring repeat renal surgery on a solitary kidney.
We reviewed the charts of patients treated at the National Cancer Institute who required repeat renal surgery from 1989 to 2010. Functional, oncological and surgical outcomes were evaluated and the costs of repeat renal surgery were calculated. We then compared costs in a cohort of 33 patients who underwent repeat renal surgery on a solitary kidney and in a hypothetical patient cohort treated with uncomplicated nephrectomy, fistula placement and dialysis. All costs were calculated based on Medicare reimbursement rates derived from CPT codes. Cost analysis was performed.
Despite a high 45% complication rate, 87% of patients maintained renal function that was adequate to avoid dialysis and 96% remained metastasis free at an average followup of 3.12 years (range 0.3 to 16.4). Compared to the hypothetical dialysis cohort, the financial benefit of repeat renal surgery was reached at 0.68 years.
Repeat renal surgery is a viable alternative for patients with multifocal renal cell carcinoma requiring multiple surgical interventions, especially when left with a solitary kidney. Despite the high complication rate, renal function is preserved in most patients and they have an excellent oncological outcome. The financial benefit of repeat renal surgery is reached at less than 1 year.
尽管多发性复发性肾细胞癌患者再次行肾切除术的发病率较高，但大多数患者保留了足够的肾功能，从而避免了透析的需要。据我们所知，重复肾手术的经济负担尚未得到评估。我们为需要在孤立肾上进行重复肾手术的患者提供了一项成本分析。
我们回顾了国家癌症研究所治疗的需要重复肾手术的患者的病历。评估了功能、肿瘤学和手术结果，并计算了重复肾手术的成本。然后，我们将在 33 名接受孤立肾上重复肾手术的患者队列中与接受单纯性肾切除术、瘘管放置和透析的假设患者队列进行比较。所有成本均根据 CPT 代码得出的 Medicare 报销率进行计算。进行了成本分析。
尽管并发症发生率高达 45%，但 87%的患者保持了足够的肾功能，避免了透析，96%的患者在平均 3.12 年（范围 0.3 至 16.4）的随访中无转移。与假设的透析队列相比，重复肾手术的经济效益在 0.68 年内达到。
对于需要多次手术干预的多发性肾细胞癌患者，重复肾手术是一种可行的替代方案，尤其是在只剩下孤立肾的情况下。尽管并发症发生率较高，但大多数患者保留了肾功能，并且具有出色的肿瘤学结果。重复肾手术的经济效益在不到 1 年内达到。
