title: Contemporary use of partial nephrectomy at a tertiary care center in the United States.
abstract: OBJECTIVE
  The use of partial nephrectomy for renal cortical tumors appears unacceptably low in the United States according to population based data. We examined the use of partial nephrectomy at our tertiary care facility in the contemporary era.
  
  
  METHODS
  Using our prospectively maintained nephrectomy database we identified 1,533 patients who were treated for a sporadic and localized renal cortical tumor between 2000 and 2007. Patients with bilateral disease or solitary kidneys were excluded from study and elective operation required an estimated glomerular filtration rate of 45 ml per minute per 1.73 m(2) or greater. Predictors of partial nephrectomy were evaluated using logistic regression models.
  
  
  RESULTS
  Overall 854 (56%) and 679 patients (44%) were treated with partial and radical nephrectomy, respectively. In the 820 patients treated electively for a tumor 4 cm or less the frequency of partial nephrectomy steadily increased from 69% in 2000 to 89% in 2007. In the 365 patients treated electively for a 4 to 7 cm tumor the frequency of partial nephrectomy also steadily increased from 20% in 2000 to 60% in 2007. On multivariate analysis male gender (p = 0.025), later surgery year (p <0.001), younger patient age (p = 0.005), smaller tumor (p <0.001) and open surgery (p <0.001) were significant predictors of partial nephrectomy. American Society of Anesthesiologists score, race and body mass index were not significantly associated with treatment type.
  
  
  CONCLUSIONS
  The use of partial nephrectomy is increasing and it is now performed in approximately 90% of patients with T1a tumors at our institution. For reasons that remain unclear certain groups of patients are less likely to be treated with partial nephrectomy.
authors.affiliation: Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: R Houston
authors.initials: RH
authors.lastname: Thompson
authors.forename: Matt
authors.initials: M
authors.lastname: Kaag
authors.forename: Andrew
authors.initials: A
authors.lastname: Vickers
authors.forename: Shilajit
authors.initials: S
authors.lastname: Kundu
authors.forename: Melanie
authors.initials: M
authors.lastname: Bernstein
authors.forename: William
authors.initials: W
authors.lastname: Lowrance
authors.forename: David
authors.initials: D
authors.lastname: Galvin
authors.forename: Guido
authors.initials: G
authors.lastname: Dalbagni
authors.forename: Karim
authors.initials: K
authors.lastname: Touijer
authors.forename: Paul
authors.initials: P
authors.lastname: Russo
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006761:Hospitals; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D014481:United States