title: Nephron sparing surgery for renal cell carcinoma up to 7 cm in the context of guideline development: a contribution of healthcare research.
abstract: BACKGROUND
  If technically feasible, organ-preservation is indicated for T1 renal cell carcinoma (RCC), since partial nephrectomy (PN) is equivalent to radical nephrectomy with regard to tumor-specific survival and probably achieves better overall survival. Treatment results of a training clinic were assessed with regard to guideline adherence and treatment quality.
  
  
  METHODS
  Based on 220 open interventions in the time periods 2006-2009 (TP1) and 2010-2013 (TP2), a retrospective single center examination was performed to determine the influence of patient-age, sex, BMI, ASA-score, preoperative eGFR, PADUA-score and surgeon's experience on PN-rate and trifecta-outcome (R0 resection, warm ischemia time ≤25 min, no intraoperative complications and no blood-transfusion and postoperative complications grade ≤1 Clavien and Dindo).
  
  
  RESULTS
  PN-rate increased from 36.1 % in TP1 to 72.4 % in TP2. Despite significantly higher PADUA-scores in TP2 than in TP1 (p = 0.0038), the trifecta-rate did not differ significantly (TP1 65.7 %; TP2 70.8 %; p = 0.666). Only the PADUA-score exerted an independent influence on the endpoints "organ-preservation" and "trifecta-outcome".
  
  
  CONCLUSIONS
  This study again demonstrated that the PADUA-score is a robust predictor of technical feasibility and treatment outcome for open PN. Consistent implementation of guidelines for nephron sparing surgery in RCC ≤7 cm is possible even in the setting of a training clinic and need not be associated with compromised treatment quality despite the increasing level of difficulty. Depending on the author, there are various definitions of trifecta-outcome. A uniform trifecta-concept would be desirable.
authors: Department of Urology and Pediatric Urology, Ruppin Clinics, Brandenburg Medical Center and School of Medicine, Fehrbelliner Straße 38, 16816, Neuruppin, Germany. s.lebentrau@ruppiner-kliniken.de.
authors: Steffen
authors: http://orcid.org/0000-0001-8782-3875
authors: S
authors: Lebentrau
authors: Department of Urology and Pediatric Urology, Ruppin Clinics, Brandenburg Medical Center and School of Medicine, Fehrbelliner Straße 38, 16816, Neuruppin, Germany.
authors: Sven
authors: S
authors: Rauter
authors: Department of Urology and Pediatric Urology, Magdeburg University Medical Center, Leipziger Str. 44, 39120, Magdeburg, Germany.
authors: Daniel
authors: D
authors: Baumunk
authors: Department of Urology and Pediatric Urology, Magdeburg University Medical Center, Leipziger Str. 44, 39120, Magdeburg, Germany.|Urology City West, Joachim-Friedrich-Str. 16, 10711, Berlin, Germany.
authors: Frank
authors: F
authors: Christoph
authors: Department of Urology and Pediatric Urology, Magdeburg University Medical Center, Leipziger Str. 44, 39120, Magdeburg, Germany.|ATURO Joint Urology Practice, Mecklenburgische Str. 27, 14197, Berlin, Germany.
authors: Frank
authors: F
authors: König
authors: Department of Urology, St. Elisabeth Hospital, St.-Elisabeth-Str. 23, 94315, Straubing, Germany.
authors: Matthias
authors: M
authors: May
authors: Department of Urology and Pediatric Urology, Magdeburg University Medical Center, Leipziger Str. 44, 39120, Magdeburg, Germany.
authors: Martin
authors: M
authors: Schostak
mesh_terms: D000367:Age Factors; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015992:Body Mass Index; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005919:Glomerular Filtration Rate; D019983:Guideline Adherence; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D059351:Organ Sparing Treatments; D011183:Postoperative Complications / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012189:Retrospective Studies; D047368:Tumor Burden; D052096:Warm Ischemia
keywords: Guideline adherence; Healthcare research; PADUA score; Partial nephrectomy; Renal cell carcinoma; Trifecta