The use of partial nephrectomy in European tertiary care centers

Purpose: The objective was to define the trends of PN use over time at six tertiary care European centers. Methods: Data were retrieved from institutional databases for patients treated with either PN or radical nephrectomy (RN) for stages T_1-2N₀M₀ renal cell carcinoma (RCC) between 1987 and 2007. For purpose of temporal trend analyses patients were divided into five equally sized groups according to the date of surgery. Categorical and multivariable logistic regression analyses assessed predictors of PN use. Results: Overall 597 (31.7%) patients were treated with PN. Overall, a 4.5-fold increase of PN was recorded. The absolute increases were 41.7-86.3%, 14.9-69.3% and 8.1-35.3% for lesions ≤2 cm, 2.1-4 cm and 4.1-7 cm (chi-square trend test p <0.001), respectively. In multivariable logistic regression models, decreasing tumor size, younger age, more contemporary date of surgery, male gender and institutional PN rate represented independent predictors of the individual probability of treatment with PN. Lack of data from community hospitals limits the generalizability of our findings. Conclusion: Based on data from six tertiary care centers, the contemporary rate of PN ranges from 86 to 35% for renal masses ≤2 cm to 4.1-7 cm and is indicative of excellent quality of care.