title: Age distribution for partial and radical nephrectomy: whose nephrons are being spared?
abstract: BACKGROUND
  Nephron sparing surgery (NSS) is recommended for patients with T1 renal cell carcinoma (RCC) whenever surgically feasible. By analyzing data from all urological clinics in the whole state of Lower Saxony, Germany, regardless of clinic size or level of expertise, we investigated whether current practice reflects the need for NSS in older patients on a broader scale.
  
  
  METHODS
  From 2005 to 2010, more than 100 medical facilities and urological clinics in Lower Saxony, Germany were evaluated for their individual rates of partial nephrectomy (PN) and radical nephrectomy (RN) based on patient's age in 5-year intervals.
  
  
  RESULTS
  Sufficient data on age were available for 3,332 out of 3,693 patients with RCC undergoing surgery. PN rates for all patients and for those with T1 RCC were 19.9% and 29.5%, respectively. For all patients with RCC, the rates for PN and RN below the median age (<66.8 years) were 365 (21.9%) and 1,302 (78.1%) and above the median age were 297 (17.8%) and 1,368 (82.2%), respectively (P = 0.003). For patients with T1 RCC, the rates for PN and RN below the median age (<66.5 years) were 341 (32.6%) and 704 (67.4%) and above the median age were 277 (26.4%) and 774 (73.6%), respectively (P = 0.002). The highest rate for each type of surgery was seen in those aged 65-70 years, except for patients with T1 RCC receiving RN who were mostly operated on when aged 70-75 years.
  
  
  CONCLUSIONS
  The rate of PN for all patients with RCC in this series and especially for patients with T1 RCC is significantly lower in older patients, thereby not reflecting the need and understanding for NSS in the higher age segment. Broader education and teaching of NSS might improve treatment of RCC in the future.
authors.affiliation: Department of Urology and Urological Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany, klot.christoph@mh-hannover.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: von Klot
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Herrmann
authors.forename: Gerd
authors.initials: G
authors.lastname: Wegener
authors.forename: Markus A
authors.initials: MA
authors.lastname: Kuczyk
authors.forename: Marie C
authors.initials: MC
authors.lastname: Hupe
authors.forename: Meryem
authors.initials: M
authors.lastname: Akkoyun
authors.forename: Inga
authors.initials: I
authors.lastname: Peters
authors.forename: Mario W
authors.initials: MW
authors.lastname: Kramer
authors.forename: Axel S
authors.initials: AS
authors.lastname: Merseburger
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005858:Germany; D006801:Humans; D007668:Kidney / Q000601:surgery; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods / Q000706:statistics & numerical data*; D009399:Nephrons / Q000601:surgery*; D059351:Organ Sparing Treatments / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult