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Trends in Renal Tumor Surgery in the United States and Germany Between 2006 and 2014: Organ Preservation Rate Is Improving

Abstract

Background

Nephron-sparing surgery (NSS) is the treatment of choice for T1 renal tumors. This study compared the implementation of NSS in the United States and Germany.

Methods

Data were derived from the National Inpatient Sample and from the Nationwide German Hospital Billing Database. All cases of NSS and radical nephrectomy from 2006 to 2014 were analyzed. To assess tumor stage distribution, data from the Surveillance, Epidemiology, and End Results database (United States) and from German cancer registries were used.

Results

The study identified 74,663 cases in the United States and 130,051 cases in Germany. The proportion of NSS for T1 tumors increased from 30.6 to 57% in the United States compared with 38.5 to 72.9% (estimation) in Germany (p < 0.001). The proportion of robotic NSS increased from 0 to 54.5% in the United States (p < 0.001) and from 0.2 to 8.6% in Germany (p < 0.001). In a multivariate model, hospitals with higher annual caseloads and a surgical robot favored NSS.

Conclusion

Patients with renal tumors might receive inhomogeneous care based on the resources of the treating institution. The robotic approach is a key driver for better implementation of NSS in the United States, and relevant potential still may exist for more organ preservation.

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Acknowledgment

The sources of data for this study were the SEER database, the U.S. Nationwide Inpatient Sample, German research data centers of the federal and state statistical offices (DRG statistics 2006–2014), and own calculations. The study was supported by a Med-Drive Grant of the Medical Faculty Carl Gustav Carus TU Dresden (Grant No. 60.356).

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Correspondence to Johannes Huber.

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Dr. Huber received personal fees from Amgen and Janssen and grants and nonfinancial support from Intuitive Surgical and Takeda, outside the submitted work. The other authors have no conflicts of interest.

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Flegar, L., Groeben, C., Koch, R. et al. Trends in Renal Tumor Surgery in the United States and Germany Between 2006 and 2014: Organ Preservation Rate Is Improving. Ann Surg Oncol 27, 1920–1928 (2020). https://doi.org/10.1245/s10434-019-08108-x

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  • DOI: https://doi.org/10.1245/s10434-019-08108-x