Pyrgidis Nikolaos, Schulz Gerald Bastian, Stief Christian, Blajan Iulia, Ivanova Troya, Graser Annabel, Staehler Michael
Department of Urology, LMU University Hospital, LMU Munich, 81377 Munich, Germany.
Cancers (Basel). 2023 Dec 24;16(1):97. doi: 10.3390/cancers16010097.
We aimed to evaluate the current trends in renal cancer surgery, as well as to compare the perioperative outcomes of partial versus radical nephrectomy.
We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005-2021). We report the largest study in the field, with 317,843 patients and multiple patient-level analyses.
Overall, 123,924 (39%) patients underwent partial and 193,919 (61%) underwent radical nephrectomy in Germany from 2005 to 2021. Of them, 57,308 (18%) were operated on in low-, 142,702 (45%) in intermediate-, and 117,833 (37%) in high-volume centers. A total of 249,333 (78%) patients underwent open, 44,994 (14%) laparoscopic, and 23,516 (8%) robotic nephrectomy. The number of patients undergoing renal surgery remained relatively stable from 2005 to 2021. Over the study period, the utilization of partial nephrectomy increased threefold, while radical nephrectomy decreased by about 40%. After adjusting for major risk factors in the multivariate regression analysis, radical nephrectomy was associated with 3.2-fold higher odds (95% CI: 3.2 to 3.9, < 0.001) of 30-day mortality, longer hospitalization by 1.9 days (95% CI: 1.9 to 2, < 0.001), and higher inpatient costs by EUR 1778 (95% CI: 1694 to 1862, < 0.001) compared to partial nephrectomy. Furthermore, radical nephrectomy had a higher risk of in-hospital transfusion ( < 0.001), sepsis ( < 0.001), acute respiratory failure ( < 0.001), acute kidney disease ( < 0.001), acute thromboembolism ( < 0.001), surgical wound infection ( < 0.001), ileus ( < 0.001), intensive care unit admission ( < 0.001), and pancreatitis ( < 0.001).
More patients are offered partial nephrectomy in Germany. Patients undergoing radical nephrectomy present with a higher rate of concomitant risk factors and have increased perioperative morbidity and mortality, prolonged hospitalization, and increased in-hospital costs.
我们旨在评估肾癌手术的当前趋势，并比较部分肾切除术与根治性肾切除术的围手术期结局。
我们使用了由联邦统计局研究数据中心提供的德国全国住院患者数据（GRAND，2005 - 2021年）。我们报告了该领域规模最大的研究，涉及317,843例患者，并进行了多项患者层面的分析。
总体而言，2005年至2021年期间，德国有123,924例（39%）患者接受了部分肾切除术，193,919例（61%）接受了根治性肾切除术。其中，57,308例（18%）在低容量中心接受手术，142,702例（45%）在中等容量中心接受手术，117,833例（37%）在高容量中心接受手术。共有249,333例（78%）患者接受了开放手术，44,994例（14%）接受了腹腔镜手术，23,516例（8%）接受了机器人辅助肾切除术。2005年至2021年期间，接受肾脏手术的患者数量保持相对稳定。在研究期间，部分肾切除术的使用率增长了两倍，而根治性肾切除术则下降了约40%。在多变量回归分析中对主要风险因素进行调整后，与部分肾切除术相比，根治性肾切除术的30天死亡率高3.2倍（95%CI：3.2至3.9，P < 0.001），住院时间延长1.9天（95%CI：1.9至2，P < 0.001），住院费用高出1778欧元（95%CI：1694至1862，P < 0.001）。此外，根治性肾切除术发生院内输血（P < 0.001）、脓毒症（P < 0.001）、急性呼吸衰竭（P < 0.001）、急性肾病（P < 0.001）、急性血栓栓塞（P < 0.001）、手术伤口感染（P < 0.001）、肠梗阻（P < 0.001）、重症监护病房入住（P < 0.001）和胰腺炎（P < 0.001）的风险更高。
在德国，更多患者接受了部分肾切除术。接受根治性肾切除术的患者伴有更高比例的合并风险因素，围手术期发病率和死亡率增加，住院时间延长，住院费用增加。
