Trends in renal tumor surgery delivery within the United States

BACKGROUND: Most small renal tumors are amenable to partial nephrectomy (PN). Studies have documented the association of radical nephrectomy (RN) with an increased risk of comorbid conditions, such as chronic kidney disease. Despite evidence of equivalent oncologic outcomes, PN remains under used within the United States. In this study, the authors identified the most recent trends in kidney surgery for small renal tumors and determined which factors were associated with the use of PN versus RN within the United States. METHODS: A population‐based patient cohort was analyzed using the Surveillance, Epidemiology and End Results cancer registry (SEER 1999‐2006). The authors identified 18,330 patients ages 40 to 90 years who underwent surgery for kidney tumors ≤4 cm in the United States between 1999 and 2006. RESULTS: In total, 11,870 patients (65%) underwent RN, and 6460 patients (35%) underwent PN. The ratio of PN to RN increased yearly (P < .001), representing 45% of kidney surgeries in 2006 for small tumors. There were significant differences in the cohort of patients who underwent PN versus RN, including age, sex, tumor location, marital status, year of treatment, and tumor size. When adjusting for these variables, being a man, age ≤70 years, urban residence, smaller tumor size, and more recent treatment year were predictors of PN. CONCLUSIONS: Although the total numbers of PN procedures increased in the United States between 1999 and 2006, there remains a significant under use of PN, particularly among women, the elderly, and those living in rural locations. Further investigation will be required to determine the reasons for these disparities, and strategies to optimize access to PN need to be developed. Cancer 2010. © 2010 American Cancer Society. Despite evidence of equivalent oncologic outcomes, analyses of population‐based databases uniformly demonstrated the under use of partial nephrectomy and disparities in the care of patients with small renal tumors in the United States. This analysis of the most recent Surveillance, Epidemiology, and End Results database (1999‐2006) indicated that significant discrepancies persist in the treatment practice patterns for older patients, women, and patients in rural settings.