title: [Indications for nephron-sparing surgery. Analysis over a 13-year period in the context of changing guidelines].
abstract: BACKGROUND
  The indications for nephron-sparing surgery have been considerably extended by guideline recommendations in recent years. It remains unclear whether clinical practice still reflects these new guidelines.
  
  
  OBJECTIVE
  In this retrospective, monocentric analysis at a tertiary referral center the indications for partial nephrectomy over a 13-year period were evaluated.
  
  
  METHODS
  In a retrospective database analysis all cases of surgically treated renal masses from 2001 to 2013 were evaluated. Besides demographic, tumor-specific and perioperative variables the development of the surgical technique depending on the tumor stage was evaluated.
  
  
  CONCLUSIONS
  The proportion of nephron-sparing surgery cases increased from below 20 % in 2001 to 35 % in 2013 in the entire cohort. For stage T1a tumors, partial nephrectomy increased from approximately 50 % to over 90 % and for T1b tumors it rose from 10 % to 50 %. Logistic regression revealed stage 1 tumors to be predictive of partial nephrectomy over the complete evaluation period. Extending the indications for partial nephrectomy even to higher stages is under discussion but not yet supported by data from prospective, controlled studies.
authors.affiliation: Klinik für Urologie und Kinderurologie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße, 35043, Marburg, Deutschland, peter.olbert@med.uni-marburg.de.
authors.forename: P J
authors.initials: PJ
authors.lastname: Olbert
authors.forename: M
authors.initials: M
authors.lastname: Maier
authors.forename: H
authors.initials: H
authors.lastname: Heers
authors.forename: A
authors.initials: A
authors.lastname: Hegele
authors.forename: R
authors.initials: R
authors.lastname: Hofmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000592:standards* / Q000706:statistics & numerical data; D009399:Nephrons / Q000601:surgery*; D059351:Organ Sparing Treatments / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome