Non-Tumoral Factors Affecting the Preference of Nephron-Sparing Surgery in the Treatment of Stage 1 Renal Cell Carcinoma Patients in Turkey

Abstract

Objective: Nephron-sparing surgery (NSS) is the first-line treatment for T1N0M0 renal tumors (RT). The aim of this multicentric retrospective study is to investigate the national trends and the effect of non-tumoral factors in the preference of NSS as treatment of T1 RT in Turkey. Materials and Methods: Relevant data for patients operated between 1997 and 2017 was collected from the Urologic Cancer Database-Kidney Urooncology Association, Turkey (UroCaD-K). Results: We included 3195 T1N0M0 RT patients in this study. There was a significant increase in the number of NSS performed with time, 9.26% between 1997-2002 to 54.78% between 2013-2017 (p<0.001). NSS proportion decreased with increasing age (p<0.001); but increased with better hospital facility (p<0.001). From multivariate analysis; younger age, later operation date, larger hospital size with higher nephrectomy centers like university hospitals were independently associated non-tumoral factors favoring NSS over radical nephrectomy (RN). Conclusion: We observed significant disparity in the use of NSS for T1 RT among the elderly (>61 years), small hospital size (<= 500 beds), lower nephrectomy volume (<100 nephrectomies/year), and Non-University Hospitals. This disparity can be resolved by persistent education of the residents and urologists with periodic courses and practical training, increasing the funds and strengthening the technical equipment of centers, thereby favoring the performance of NSS even in smaller centers. This will ensure that suitable patients are treated with NSS rather than RN, regardless of the hospital type.