Trends in the operative management of renal tumors over a 14-year period.
OBJECTIVE
To review the trends in the operative management of renal tumours over a 14-year period at a university hospital, as the therapeutic options available for treating renal tumours have increased over the past decade.


METHODS
The study was a retrospective chart review of 1621 consecutive patients undergoing treatment for renal tumours from January 1991 to March 2005. The characteristics assessed included patient demographics, tumour size, operative duration and treatment.


RESULTS
During the study period, 624 (38.6%) open, 883 (54.6%) laparoscopic and 111 (6.7%) percutaneous approaches were performed. The number of renal tumours treated increased annually, as did the use of minimally invasive techniques (93.4% in 2005). Conversely, the number of open surgical treatments used declined both absolutely and proportionally. Over the study period, for tumours of <or=4 cm, laparoscopic partial nephrectomy was the most common approach (41.0%). Percutaneous ablation has also made an impact as a treatment method for small tumours (13.8% in 2005). For tumours of >7 cm, open radical nephrectomy (ORN) was the most common method of treatment over all years. However, since 2002, laparoscopic radical nephrectomy (LRN) surgery has been increasingly used over ORN for treating this tumour group (73% LRN vs 19.2% ORN in 2004).


CONCLUSIONS
The available treatment options for renal tumours have increased significantly since the early 1990s. At a university hospital in which there are physicians with a specific interest in minimally invasive surgery and ablative treatments, minimally invasive approaches have become the standard treatment.
Permpongkosol
Sompol
S
Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Bagga
Herman S
HS
Romero
Frederico R
FR
Solomon
Stephen B
SB
Kavoussi
Louis R
LR
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D017115:Catheter Ablation / Q000639:trends; D003452:Cryosurgery / Q000639:trends; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000639:trends; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013520:Urologic Surgical Procedures / Q000639:trends*