Contemporary different patterns of indications and outcomes for the surgical management of renal tumors in an academic center.
OBJECTIVE
Inconsistencies have been pointed out in the treatment of small renal tumors by laparoscopists, as many would remove the entire kidney unnecessarily, whereas open surgeons are more likely to perform partial nephrectomy. Thus, we compared the practice and outcomes between two groups of surgeons treating renal tumors.


METHODS
We reviewed the renal cancer database from our institution from January 2000 to October 2006 for data retrieval and analysis. The patients treated by the laparoscopy staff (LS) and the oncology staff (OS) were divided into two groups for comparison. Data were collected for age, gender, type of surgery performed, time of operation, length of stay in the hospital, complications, histological evaluation, operation room time, hospital stay time, complications rate, and overall survival.


RESULTS
A total of 240 patients were evaluated, 149 in the LS group (62%) and 91 in the OS group (38%), and the results have been summarized. Fifty percent of all procedures were open; however, in the OS group 100% of the surgeries were open and in the LS group 19% of the cases were open. Interestingly, only 9% of the surgeries in the OS group were nephron sparing, whereas in the LS group 60% of the patients had their kidneys spared. OS treated a higher percentage of locally advanced tumors.


CONCLUSIONS
Laparoscopists performed a more variety of surgical approaches including open procedures and performed much more nephron sparing surgeries than the oncologists. Open surgery still plays an important role for locally advanced disease and hilar tumors.
Division of Urology, Federal University of Sao Paulo, Sao Paulo, Brazil.
Rodrigo K
RK
Krebs
Cassio
C
Andreoni
Walid
W
Khalil
Valdemar
V
Ortiz
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D003710:Demography; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult