Time trends in service provision and survival outcomes for patients with renal cancer treated by nephrectomy in England 2000–2010

• Published in: BJU international Vol. 122; no. 4; pp. 599 - 609
• Main Authors: Hsu, Ray C. J., Barclay, Matthew, Loughran, Molly A., Lyratzopoulos, Georgios, Gnanapragasam, Vincent J., Armitage, James N.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.10.2018; John Wiley and Sons Inc
• Subjects: Aged; centralisation; Delivery of Health Care - statistics & numerical data; England - epidemiology; Female; Geriatrics; Hospitals; Humans; Kidney cancer; Kidney Neoplasms - surgery; KidneyCancer; Male; Middle Aged; Mortality; Nephrectomy; Nephrectomy - statistics & numerical data; Nephrons; Organ Sparing Treatments - statistics & numerical data; postoperative outcomes; Practice Patterns, Physicians' - statistics & numerical data; renal cancer; Renal cell carcinoma; Retrospective Studies; Surgeons; Surgery; survival; Survival Analysis; Time Factors; Treatment Outcome; Trends; Urological Oncology; England; centralisation; postoperative outcomes; renal cancer; nephrectomy; KidneyCancer; survival
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/bju.14217

Objective To describe the temporal trends in nephrectomy practice and outcomes for English patients with renal cell carcinoma (RCC). Patients and Methods Adult RCC nephrectomy patients treated between 2000 and 2010 were identified in the National Cancer Data Repository and Hospital Episode Statistics, and followed‐up until date of death or 31 December 2015 (n = 30 763). We estimated the annual frequency for each nephrectomy type, the hospital and surgeon numbers and their case volumes. We analysed short‐term surgical outcomes, as well as 1‐ and 5‐year relative survivals. Results Annual RCC nephrectomy number increased by 66% during the study period. Hospital number decreased by 24%, whilst the median annual hospital volume increased from 10 to 23 (P < 0.01). Surgeon number increased by 27% (P < 0.01), doubling the median consultant number per hospital. The proportion of minimally invasive surgery (MIS) nephrectomies rose from 1% to 46%, whilst the proportion of nephron‐sparing surgeries (NSS) increased from 5% to 16%, with 29% of all T1 disease treated with partial nephrectomy in 2010 (P < 0.01). The 30‐day mortality rate halved from 2.4% to 1.1% and 90‐day mortality decreased from 4.9% to 2.6% (P < 0.01). The 1‐year relative survival rate increased from 86.9% to 93.4%, whilst the 5‐year relative survival rate rose from 68.2% to 81.2% (P < 0.01). Improvements were most notable in patients aged ≥65 years and those with T3 and T4 disease. Conclusions Surgical RCC management has changed considerably with nephrectomy centralisation and increased NSS and MIS. In parallel, we observed significant improvements in short‐ and long‐term survival particularly for elderly patients and those with locally advanced disease.