title: The Adoption of Nephron-Sparing Surgery in Europe - A Trend Analysis in Two Referral Centers from Austria and Germany.
abstract: OBJECTIVE
  To compare the trends of partial nephrectomy (PN) and radical nephrectomy (RN) in 2 European tertiary referral centers with regards to guideline changes.
  
  
  METHODS
  A total of 1,573 patients who underwent RN or PN for localized (≤T2) renal cell carcinoma (RCC) were included. Logistic regression analyses assessed the predictors of PN and laparoscopy over time.
  
  
  RESULTS
  Out of the total, 1,013 patients (65.6%) were treated with RN and 560 patients (34.4%) with PN. Also, 1,233 patients (80%) had open surgery whereas 340 patients (22%) were treated with a laparoscopic approach. Laparoscopic RN and PN were performed in 216 (13.7%) and 124 (7.8%) patients, respectively. T1b tumors were 73% less likely (p < 0.001) to be treated with PN compared to T1a tumors. The odds of undergoing PN or laparoscopy in 2008-2010 relative to 2000-2001 were 6.5-fold (p < 0.001) and 36-fold higher (p < 0.001), respectively.
  
  
  CONCLUSIONS
  Tumor size and year of surgery are independent predictors of PN in our cohort. Our data exemplify the adoption of PN for RCC in tertiary care centers in Austria and Germany in line with implemented guideline changes. The utilization of PN has increased over time regardless of surgical approach. Further studies need to address the use of robot-assisted surgery and care in community hospitals.
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Meyer
authors.forename: Jens
authors.initials: J
authors.lastname: Hansen
authors.forename: Andreas
authors.initials: A
authors.lastname: Becker
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid
authors.forename: Lea
authors.initials: L
authors.lastname: Pradel
authors.forename: Karin
authors.initials: K
authors.lastname: Strini
authors.forename: Thomas
authors.initials: T
authors.lastname: Chromecki
authors.forename: Johanna
authors.initials: J
authors.lastname: Jesche-Chromecki
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Felix K H
authors.initials: FK
authors.lastname: Chun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005858:Germany; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D009399:Nephrons / Q000601:surgery*; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D012044:Regression Analysis; D065287:Robotic Surgical Procedures / Q000379:methods