Increasing use of kidney sparing approaches for localized renal tumors in a community based health system: impact on renal functional outcomes

Purpose: The use of partial nephrectomy and other kidney sparing approaches in national databases lags far behind practice patterns at major academic centers. The reasons and impact of this disparity are largely unknown. We examined the trend in kidney sparing approaches in a community based health care system to examine associated factors and impact on renal function.

Materials and methods: We evaluated the records of all patients who underwent intervention for suspicious renal lesions at a single health care system between 1998 and 2010. Demographic, pathological and functional data were collected in an institutional review board approved database.

Results: During the 12 study years a kidney sparing approach was used in 35% of patients with localized renal tumors. A clear increase in the proportion of patients undergoing a kidney sparing approach was observed, including 11%, 23% and 49% during successive 4-year periods. A kidney sparing approach was used in 81% of patients with tumors 4 cm or less during 2009 to 2010. Although high volume (greater than 20 cases annually), more recently graduating (2001 or later) and fellowship trained surgeons had higher kidney sparing approach use overall (each p <0.03), the proportion of patients who underwent a kidney sparing approach increased with time in all study groups (p <0.0001). The renal functional loss in patients who underwent a kidney sparing approach and radical nephrectomy was 2% and 30%, respectively (p <0.001).

Conclusions: The kidney sparing approach rate in a community based health care system can approach rates at major academic centers. This practice pattern appears related to the addition of recent graduates and urological oncologists but also to a change in long-standing practice patterns of other community urologists. These data suggest that the use of kidney sparing approaches nationwide and the associated renal functional benefits may continue to increase.