title: Changing patterns in the surgical management of renal masses.
abstract: OBJECTIVE
  To describe the temporal trends in surgical techniques for the management of renal masses at a single Spanish academic institution and identify factors associated with partial nephrectomy (PN) decision.
  
  
  METHODS
  A total of 646 patients were treated by surgery for clinically localised renal masses from January 2004 to December 2012 at a tertiary referral center. Surgical techniques included open radical nephrectomy (RN), open PN, laparoscopic RN, and laparoscopic PN. Descriptive statistics were used to compare baseline characteristics and proportions of patients treated by different surgical techniques. Annual trends in the proportion of procedures performed were determined. Adjusted odds ratios (OR) and 95% confidence intervals were calculated to evaluate clinical variables predictive of PN.
  
  
  RESULTS
  During the 9-year study period, the proportion of PN relative to RN increased from 21% to 55%. With regard to surgical approach, open procedures for both RN and PN decreased gradually in favor of minimally invasive approaches (83% in 2004 to 4% in 2011-2012). While median tumor size did not significantly change over the study period, laparoscopic PN became the most commonly performed kidney procedure in 2011-2012 (49% of all procedures). Clinical variables independently predictive of partial nephrectomy were ASA score, baseline renal function and tumor size (all P<.05).
  
  
  CONCLUSIONS
  At our academic institution, temporal trends in the management of renal masses have established PN as the most common surgical option. Although PN was increasingly used over the study period, a parallel increase in minimally invasive approaches for RN and PN was seen.
authors.affiliation: Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, España. Electronic address: tonivilaseca@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Vilaseca
authors.affiliation: Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Musquera
authors.affiliation: Departmento de Urología, Universidad de Berna, Berna, Suiza.
authors.forename: D P
authors.initials: DP
authors.lastname: Nguyen
authors.affiliation: Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: G
authors.initials: G
authors.lastname: Di Paola
authors.affiliation: Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: L R
authors.initials: LR
authors.lastname: Romeo
authors.affiliation: Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Melnick
authors.affiliation: Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: E
authors.initials: E
authors.lastname: García-Cruz
authors.affiliation: Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: M J
authors.initials: MJ
authors.lastname: Ribal
authors.affiliation: Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Huguet
authors.affiliation: Departamento de Urología, Hospital Clínic de Barcelona, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Alcaraz
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D010818:Practice Patterns, Physicians'
keywords: Abordaje mínimamente invasivo; Minimally invasive approaches; Nefrectomía parcial; Nefrectomía radical; Partial nephrectomy; Radical nephrectomy