Pearson John, Williamson Timothy, Ischia Joseph, Bolton Damien M, Frydenberg Mark, Lawrentschuk Nathan
Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia.
Department of Surgery, Monash University, Melbourne, Australia.
Korean J Urol. 2015 Sep;56(9):607-13. doi: 10.4111/kju.2015.56.9.607. Epub 2015 Sep 7.
Nephrectomy is the cornerstone therapy for renal cell carcinoma (RCC) and continued refinement of the procedure through research may enhance patient outcomes. A national nephrectomy registry may provide the key information needed to assess the procedure at a national level. The aim of this study was to review nephrectomy data available at a population-based level in Australia and to benchmark these data against data from the rest of the world as an examination of the national nephrectomy registry model. A PubMed search identified records pertaining to RCC nephrectomy in Australia. A similar search identified records relating to established nephrectomy registries internationally and other surgical registries of clinical importance. These records were reviewed to address the stated aims of this article. Population-based data within Australia for nephrectomy were lacking. Key issues identified were the difficulty in benchmarking outcomes and no ongoing monitoring of trends. The care centralization debate, which questions whether small-volume centers provide comparable outcomes to high-volume centers, is ongoing. Patterns of adherence and the effectiveness of existing protocols are uncertain. A review of established international registries demonstrated that the registry model can effectively address issues comparable to those identified in the Australian literature. A national nephrectomy registry could address deficiencies identified in a given nation's nephrectomy field. The model is supported by evidence from international examples and will provide the population-based data needed for studies. Scope exists for possible integration with other registries to develop a more encompassing urological or surgical registry. Need remains for further exploration of the feasibility and practicalities of initiating such a registry including a minimum data set, outcome indicators, and auditing of data.
肾切除术是肾细胞癌（RCC）的基石性治疗方法，通过研究持续改进该手术可能会改善患者预后。国家肾切除术登记处可能提供在国家层面评估该手术所需的关键信息。本研究的目的是回顾澳大利亚基于人群层面可得的肾切除术数据，并将这些数据与世界其他地区的数据进行对比，以此检验国家肾切除术登记处模式。一项PubMed检索确定了与澳大利亚RCC肾切除术相关的记录。类似的检索确定了国际上已建立的肾切除术登记处以及其他具有临床重要性的外科手术登记处的相关记录。对这些记录进行了回顾，以实现本文所述目标。澳大利亚缺乏基于人群的肾切除术数据。确定的关键问题包括难以对结果进行对比以及缺乏对趋势的持续监测。关于医疗集中化的争论仍在继续，该争论质疑小容量中心能否提供与大容量中心相当的治疗效果。现有方案的依从模式和有效性尚不确定。对已建立的国际登记处的回顾表明，登记处模式能够有效解决与澳大利亚文献中所确定问题类似的问题。国家肾切除术登记处可以解决特定国家肾切除术领域中发现的不足。该模式得到了国际实例证据的支持，并将提供研究所需的基于人群的数据。存在与其他登记处进行整合以建立更全面的泌尿外科或外科登记处的可能性。仍需进一步探索启动这样一个登记处的可行性和实际操作，包括最小数据集、结果指标以及数据审核。
