title: Surgery for renal cell carcinoma in two European urologic clinics: to compare or compete?
abstract: OBJECTIVE
  To evaluate and compare the incidence, TNM staging and the current strate- gy for the surgical treatment of renal cell carcinoma (RCC) in two European urologic institutions, situated in Varna, Bulgaria and in Bari, Italy. Both clinics have sound experience of RCC surgery, and modern laparoscopic equipment. A retrospective chart review of all patients with RCC diagnosed and treated in the last year was conducted at the two sites.
  
  
  METHODS
  In total, 88 patients (66 males and 22 females, mean age 58 years, range 24-81 years) were enrolled in the study. Comparisons were made between some clinical and pathologic parameters with an established prognostic and therapeutic impact. The type of surgery perormed at both sites was analyzed as well. All these comparative studies were performed in relation to the 2008 EAU guidelines on the current management of RCC. Commercially available statistical software was used for the purpose.
  
  
  RESULTS
  The results showed no difference between the two sites regarding the RCC incidence and the patients' age and gender. Significant differences (p value < 0.0001) emerged in terms of: the median size of the tumors at surgery (8.5 cm in Varna, SD + 4.04 vs. 4.4 cm in Bari, SD _ 2.02); T-stage of the tumor (Varna T T2-30%, T3-22%, T4-15% vs. Bari T1-64%, T2-12%, T3-24%, T4-0%); N-positive disese (24% vs. 2%); distant metastases (20% vs. 2%) and presence of necrosis in the renal masses (37% vs. 19%). Thus, 85% of Varna patients underwent open radical nephrectomy, 11% nephron-sparing surgery and 4% explorative laparotomy, due to inoperability of the renal mass. Only 29% of Bari patients were treated by open radical nephrectomy, 12% underwent laparoscopic nephrectomy, 57% open partial nephrectomy and 2% laparoscopic partial tumor resection.
  
  
  CONCLUSIONS
  These numbers demonstrate more advantageous tumour features at the Italian clinic in terms of organ-sparing surgical options (open and laparoscopic), whereas in the Bulgarian clinic the tumour features pose certain limitations to the application of modern surgical techniques. This difference is due to early diagnosis of RCC in Italy, allowing treatment of smaller volume tumors.
authors.affiliation: St. Marina University Hospital, Third Clinic of Surgery, Division of Urology, Varna, Bulgaria. sve_dyakov@yahoo.com
authors.forename: Svetoslav Dechev
authors.initials: SD
authors.lastname: Dyakov
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucarelli
authors.forename: Alexander Ivanov
authors.initials: AI
authors.lastname: Hinev
authors.forename: Petar Kirilov
authors.initials: PK
authors.lastname: Chankov
authors.forename: Deyan
authors.initials: D
authors.lastname: Anakievski
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ditonno
authors.forename: Pasquale
authors.initials: P
authors.lastname: Martino
authors.forename: Francesco Paolo
authors.initials: FP
authors.lastname: Selvaggi
authors.forename: Michele
authors.initials: M
authors.lastname: Battaglia
mesh_terms: D002031:Bulgaria; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007558:Italy; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies