title: Rates of open versus laparoscopic and partial versus radical nephrectomy for T1a renal cell carcinoma: a population-based evaluation.
abstract: OBJECTIVE
  To examine the trends of open and laparoscopic partial nephrectomy and radical nephrectomy according to sociodemographic and tumor characteristics.
  
  
  METHODS
  Using the Surveillance, Epidemiology, and End Results Medicare-linked database, 6024 patients diagnosed with T1a renal cell carcinoma were abstracted. Multivariable logistic regression analyses were used for prediction of open radical nephrectomy, open partial nephrectomy, laparoscopic radical nephrectomy and laparoscopic partial nephrectomy. Covariates comprised of patient age, baseline comorbidity status, sex, race, marital status, socioeconomic status, population density, Surveillance, Epidemiology and End Results registry, tumor size, and year of diagnosis.
  
  
  RESULTS
  Open radical nephrectomy decreased from 89% in 1988 to 66% in 2005 (P < 0.001), whereas open partial nephrectomy increased from 7% to 29% (P < 0.001). Meanwhile, utilization of either laparoscopic radical nephrectomy or laparoscopic partial nephrectomy remained low. Treatment utilization differed according to Surveillance, Epidemiology, and End Results registries (P < 0.001). Increasing patient age, female sex, low socioeconomic status and unmarried status (all P ≤ 0.003) were predictors of open radical nephrectomy. The utilization rates of laparoscopic radical nephrectomy or laparoscopic partial nephrectomy varied minimally according to the examined characteristics. Older patients or women were significantly more likely to undergo laparoscopic radical nephrectomy, even after adjustment for all covariates (both P ≤ 0.02).
  
  
  CONCLUSIONS
  The rising utilization rates of radical nephrectomy are encouraging. Nevertheless, disparities of treatment type still exist. It is of concern that older and female patients are less likely to undergo nephron-sparing surgery, and to have a radical nephrectomy by the laparoscopic approach instead.
authors: Cancer Prognostics and Health Outcomes Unit, Vita Salute San Raffaele University, Milan, Italy; Department of Urology, Vita Salute San Raffaele University, Milan, Italy.
authors: Marco
authors: M
authors: Bianchi
authors: Andreas
authors: A
authors: Becker
authors: Firas
authors: F
authors: Abdollah
authors: Quoc-Dien
authors: QD
authors: Trinh
authors: Jens
authors: J
authors: Hansen
authors: Zhe
authors: Z
authors: Tian
authors: Shahrokh F
authors: SF
authors: Shariat
authors: Paul
authors: P
authors: Perrotte
authors: Pierre I
authors: PI
authors: Karakiewicz
authors: Maxine
authors: M
authors: Sun
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000639:trends; D008297:Male; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000706:statistics & numerical data / Q000639:trends*; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States
keywords: laparoscopic nephrectomy; open nephrectomy; partial nephrectomy; radical nephrectomy; renal cell carcinoma; time trends