Division of Surgery and Interventional Science, University College London, London, UK.
Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.
BJU Int. 2020 Jan;125(1):73-81. doi: 10.1111/bju.14862. Epub 2019 Aug 18.
To assess European Association of Urology guideline adherence on the surgical management of patients with T1 renal tumours and the effects of centralisation of care.
Retrospective data from all kidney tumours that underwent radical nephrectomy (RN) or partial nephrectomy (PN) in the period 2012-2016 from the British Association of Urological Surgeons Nephrectomy Audit were retrieved and analysed. We assessed total surgical hospital volume (HV; RN and PN performed) per centre, PN rates, complication rates, and completeness of data. Descriptive analyses were performed, and confidence intervals were used to illustrate the association between hospital volume and proportion of PN. Chi- squared and Cochran-Armitage trend tests were used to evaluate differences and trends.
In total, 13 045 surgically treated T1 tumours were included in the analyses. Over time, there was an increase in PN use (39.7% in 2012 to 44.9% in 2016). Registration of the Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) complexity score was included in March 2016 and documented in 39% of cases. Missing information on postoperative complications appeared constant over the years (8.5-9%). A clear association was found between annual HV and the proportion of T1 tumours treated with PN rather than RN (from 18.1% in centres performing <25 cases/year [lowest volume] to 61.8% in centres performing ≥100 cases/year [high volume]), which persisted after adjustment for PADUA complexity. Overall and major (Clavien-Dindo grade ≥III) complication rate decreased with increasing HV (from 12.2% and 2.9% in low-volume centres to 10.7% and 2.2% in high-volume centres, respectively), for all patients including those treated with PN.
Closer guideline adherence was exhibited by higher surgical volume centres. Treatment of T1 tumours using PN increased with increasing HV, and was accompanied by an inverse association of HV with complication rate. These results support the centralisation of kidney cancer specialist cancer surgical services to improve patient outcomes.
评估欧洲泌尿外科学会（EAU）关于 T1 期肾肿瘤手术治疗的指南遵循情况，以及集中治疗的效果。
从英国泌尿外科学会肾切除术审计的 2012 年至 2016 年期间所有接受根治性肾切除术（RN）或部分肾切除术（PN）的肾肿瘤患者的回顾性数据中检索并分析。我们评估了每个中心的总手术医院容量（RN 和 PN 之和）、PN 率、并发症发生率以及数据的完整性。进行了描述性分析，并使用置信区间说明医院容量与 PN 比例之间的关联。使用卡方检验和 Cochran-Armitage 趋势检验评估差异和趋势。
共纳入 13 045 例接受手术治疗的 T1 肿瘤患者。随着时间的推移，PN 的使用率逐渐增加（2012 年为 39.7%，2016 年为 44.9%）。术前方面和解剖学使用的维度（PADUA）评分于 2016 年 3 月开始登记，并在 39%的病例中记录。多年来，术后并发症的缺失信息似乎保持不变（8.5-9%）。每年的 HV 与 T1 肿瘤采用 PN 治疗而不是 RN 治疗的比例之间存在明显的关联（从每年手术量<25 例的中心（最低容量）的 18.1%到每年手术量≥100 例的中心（高容量）的 61.8%），这一关联在调整了 PADUA 复杂性评分后仍然存在。所有患者（包括接受 PN 治疗的患者）的总体和主要（Clavien-Dindo 分级≥III）并发症发生率随着 HV 的增加而降低（从低容量中心的 12.2%和 2.9%分别降至高容量中心的 10.7%和 2.2%）。
手术量较高的中心更严格地遵循指南。随着 HV 的增加，使用 PN 治疗 T1 肿瘤的比例增加，而 HV 与并发症发生率呈反比。这些结果支持将肾癌专科癌症手术服务集中化，以改善患者的预后。
