title: Unintended consequences of laparoscopic surgery on partial nephrectomy for kidney cancer.
abstract: OBJECTIVE
  Recent evidence suggests that partial nephrectomy may be associated with improved survival compared to radical nephrectomy for renal cell carcinoma but partial nephrectomy may be underused. We examined whether the introduction of laparoscopic radical nephrectomy contributed to low partial nephrectomy use with time.
  
  
  METHODS
  We identified all patients treated surgically for renal cell carcinoma in Ontario, Canada between 1995 and 2004 using the Ontario Cancer Registry, a population based tumor registry. A multinomial logistic regression model was used to relate the relative numbers of patients with open and laparoscopic radical nephrectomy, and partial nephrectomy to patient age, gender and surgery year. The partial nephrectomy time trend was investigated by fitting a segmented regression model.
  
  
  RESULTS
  Of 7,830 surgically treated patients 7,042 (89.9%) vs 788 (10.1%) underwent radical vs partial nephrectomy. Segmented regression showed a clear change in partial nephrectomy use with time (p = 0.001), such that the odds of partial nephrectomy increased by 18% per year before January 2003 (OR 1.18, 95% CI 1.14-1.23) and subsequently decreased by 12% per year (OR 0.88, 95% CI 0.75-1.02). In the multinomial regression model age and surgery year but not gender were independently associated with partial nephrectomy.
  
  
  CONCLUSIONS
  Partial nephrectomy use for renal cell carcinoma remains low, particularly in elderly patients. The introduction of laparoscopic radical nephrectomy coincided with decreased uptake and use of partial nephrectomy for renal cell carcinoma. Although it was hypothesized previously, to our knowledge this is the first study to suggest that the introduction of laparoscopy in renal surgery has negatively impacted partial nephrectomy use.
authors.affiliation: Division of Urologic Oncology, Princess Margaret Hospital and Department of Health Policy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Abouassaly
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
authors.forename: George
authors.initials: G
authors.lastname: Tomlinson
authors.forename: Narhari
authors.initials: N
authors.lastname: Timilshina
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies