A survey of follow-up practice of urologists across Britain and Ireland following nephrectomy for renal cell carcinoma.
OBJECTIVE
To determine the follow-up protocol for interval assessment of patients following radical nephrectomy for renal cell cancer and to compare them with the recommendations proposed in the literature.


METHODS
Consultant urologists across Britain and Ireland completed a postal questionnaire. One follow-up mailing was used to encourage non-responders. The responses were analysed in the light of the recommendations from European Association of Urology and American guidelines. Also information was collected from the respondents on the choice of follow-up investigations for renal cell cancer and the total duration of follow-up.


RESULTS
Of the 480 urologists surveyed 292 (60.8%) responded. Most respondents recommended regular follow-up with chest radiography (CR), ultrasound and computed tomography (CT). For T1 disease CR was requested by 28, 62 and 55%; for T2 disease by 30, 66 and 51%; for T3 disease by 39, 63, and 48% at 3, 6 and 12 months, respectively. For T1 disease US was requested by 5, 23 and 30%; for T2 disease 6, 27 and 30%; for T3 disease 8, 25, and 26% at 3, 6 and 12 months, respectively. For T1 disease an abdominal CT was requested by 2, 17 and 21%; for T2 disease 3.7, 19.5 and 26%; for T3 disease 10, 31, and 33% at 3, 6 and 12 months, respectively. Only one respondent followed the guidelines suggested in the literature. Further follow-up after 12 months for 5 and 10 years was suggested by 58.2 and 21.3% for T1, 53 and 24.73% for T2, and 45.5 and 25.5% for T3, respectively. There is appreciable variation in the frequency of use and timing of imaging.


CONCLUSIONS
Most respondents perform follow-up after radical nephrectomy in patients with renal cancer, with considerable variability in their practices. In the current increasingly cost-conscious healthcare industry a scientifically justified follow-up should be considered.
Basu
S
S
Castle Hill Hospital, Hull, UK.
Biyani
Chandra Shekhar
CS
Sundaram
S K
SK
Spencer
J
J
D002292:Carcinoma, Renal Cell / Q000601:surgery*; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007494:Ireland; D007680:Kidney Neoplasms / Q000601:surgery*; D009392:Nephrectomy; D011182:Postoperative Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D006113:United Kingdom; D014572:Urology / Q000592:standards*