Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia.
ANZ J Surg. 2024 Jun;94(6):1071-1075. doi: 10.1111/ans.18920. Epub 2024 Mar 1.
In 2015 our centre introduced a nurse-led renal cell cancer follow-up protocol and clinic for patients who have undergone partial or radical nephrectomy for organ-confined kidney tumours. The main aims of this clinic were to improve healthcare efficiency and standardize follow-up processes.
The primary objective was to assess the effectiveness of a nurse-led renal cell cancer follow up clinic in regard to surveillance protocol compliance and the timely identification and appropriate management of recurrences. A secondary objective was to evaluate this locally developed follow up protocol against the current European Association of Urology (EAU) guidelines surveillance protocol.
All patients who underwent a partial or radical nephrectomy between 2015 and 2021 at a single Western Australia institution for a primary renal malignancy were included. Data was collected from local clinical information systems and protocol adherence, recurrence characteristics and management were assessed. The current EAU guidelines were applied to the cohort to assess differences in risk-stratification and theoretical outcomes between the protocols.
After a mean follow up period of 31.2 months (range 0-77 months), 75.5% (185/245) of patients had all follow up imaging and reviews within 1 month of the timeframe scheduled on the protocol. 17.1% (42/245) had a delay in their follow up of more than a month at some stage, 5.7% (14/245) did not attend for follow up but had documented attempts to facilitate their compliance, and 0.4% (1/245) were lost to follow up with no evidence of attempted contact. 15.5% (38/245) of patients had recurrence of malignancy detected during follow up and these were all discussed in a multi-disciplinary team (MDT) meeting. The recurrence rate was 2.5% (3/119) for low risk, 17.7% (14/79) for intermediate risk, and 44.7% (21/47) for high risk patients when they were re-stratified according to EAU risk categories. No recurrences were detected through ultrasound (USS) or chest x-ray (CXR) in this cohort and our protocol tended to place patients in higher risk-stratification groups as compared to current EAU guidelines.
Nurse-led renal cell cancer follow up is a safe, reliable and effective clinical framework that has significant benefits in regard to resource utilization. USS and CXR are ineffective in detecting recurrence and Computerized tomography (CT) should be considered the imaging modality of choice for this purpose. The EAU surveillance protocol appears superior to our protocol, and we have therefore transitioned to the EAU guideline protocol going forward.
2015 年，我们中心引入了一种由护士主导的肾细胞癌随访方案和诊所，为接受部分或根治性肾切除术治疗局限性肾肿瘤的患者提供服务。该诊所的主要目的是提高医疗保健效率并规范随访流程。
主要目的是评估由护士主导的肾细胞癌随访诊所在监测方案依从性以及及时发现和适当管理复发方面的有效性。次要目的是将本地开发的随访方案与当前欧洲泌尿外科学会（EAU）指南监测方案进行比较。
所有在单一西澳大利亚机构接受部分或根治性肾切除术治疗原发性肾恶性肿瘤的患者均纳入研究。数据来自本地临床信息系统，评估了方案依从性、复发特征和管理情况。将当前 EAU 指南应用于该队列，以评估两种方案在风险分层和理论结果方面的差异。
在平均 31.2 个月（0-77 个月）的随访期后，75.5%（185/245）的患者在协议规定的时间范围内，所有随访影像学检查和复查均在 1 个月内完成。17.1%（42/245）在某个阶段的随访中出现了超过 1 个月的延迟，5.7%（14/245）未进行随访，但有记录表明已尝试使其依从，0.4%（1/245）失访且无试图联系的证据。15.5%（38/245）的患者在随访中发现恶性肿瘤复发，所有患者均在多学科团队（MDT）会议上进行了讨论。根据 EAU 风险分类，低危患者的复发率为 2.5%（3/119），中危患者为 17.7%（14/79），高危患者为 44.7%（21/47）。本队列中未通过超声（USS）或胸部 X 线（CXR）检测到复发，并且我们的方案与当前 EAU 指南相比，倾向于将患者归入更高的风险分层组。
由护士主导的肾细胞癌随访是一种安全、可靠且有效的临床框架，在资源利用方面具有显著优势。USS 和 CXR 无法有效检测复发，应考虑 CT 作为此目的的首选影像学检查方法。EAU 监测方案优于我们的方案，因此我们已转向 EAU 指南方案。
