Urologic oncology · 2025
Utilization of radical nephrectomy for patients with clinical stage T1 renal masses: Evaluation of opportunities for quality improvement.
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Semerjian Alice, Fisher Emily, Patel Amit, Johnson Anna, Van Til Monica, Noyes Sabrina L, Seifman Brian, Johnston William K, Hafron Jason, Maatman Thomas, Rogers Craig G, Lane Brian R
Аннотация
PURPOSE: To determine opportunities for quality improvement (QI) in patient selection for radical nephrectomy (RN) for cT1 renal masses (cT1RM).
MATERIALS AND METHODS: The MUSIC (Michigan Urological Surgery Improvement Collaborative) registry was queried for RN performed for any localized RM ≤4 cm (cT1aRM) or low/intermediate/unrecorded complexity RM 4 to 7 cm (cT1bRM). Eight experienced kidney surgeons reviewed characteristics (age, GFR, medical comorbidities, RENAL score, tumor size, and more) of de-identified cases. Each reviewer provided a score regarding opportunity for QI (none = 0, minor = 1, moderate = 2, major = 3) that were averaged.
RESULTS: 171 cases met inclusion criteria, including 77 cT1aRM and 94 cT1bRM. Urologists agreed on a score of no (0) or minor (0.1-1) QI opportunities in 40% (n = 68) and 41% (n = 70) of cases, respectively. These patients had (1) ≥1 of the following features: on dialysis; elderly, comorbid, or anticoagulated with normal GFR; (2) cT1bRM and RENAL ≥8; (3) not amenable to partial nephrectomy (PN) or biopsy based on location or cystic nature; or (4) attempted PN. Thirty-three cases had moderate (14%) or major (4%) QI opportunities including 30% of cT1aRM and 11% of reviewed cT1bRM. Case characteristics included: smaller and/or lower complexity tumors, younger age, baseline CKD, and/or would have benefitted from active surveillance and/or pretreatment biopsy.
CONCLUSIONS: Surgeon-reviewers identified moderate/major opportunities for QI in 33 patients that underwent RN who may have been spared from kidney loss. Kidney loss can be prevented by considering active surveillance, confirmatory imaging, renal mass biopsy, and/or kidney-sparing interventions in patients with T1aRM, low/intermediate complexity T1bRM, young patients, and patients with CKD.
MATERIALS AND METHODS: The MUSIC (Michigan Urological Surgery Improvement Collaborative) registry was queried for RN performed for any localized RM ≤4 cm (cT1aRM) or low/intermediate/unrecorded complexity RM 4 to 7 cm (cT1bRM). Eight experienced kidney surgeons reviewed characteristics (age, GFR, medical comorbidities, RENAL score, tumor size, and more) of de-identified cases. Each reviewer provided a score regarding opportunity for QI (none = 0, minor = 1, moderate = 2, major = 3) that were averaged.
RESULTS: 171 cases met inclusion criteria, including 77 cT1aRM and 94 cT1bRM. Urologists agreed on a score of no (0) or minor (0.1-1) QI opportunities in 40% (n = 68) and 41% (n = 70) of cases, respectively. These patients had (1) ≥1 of the following features: on dialysis; elderly, comorbid, or anticoagulated with normal GFR; (2) cT1bRM and RENAL ≥8; (3) not amenable to partial nephrectomy (PN) or biopsy based on location or cystic nature; or (4) attempted PN. Thirty-three cases had moderate (14%) or major (4%) QI opportunities including 30% of cT1aRM and 11% of reviewed cT1bRM. Case characteristics included: smaller and/or lower complexity tumors, younger age, baseline CKD, and/or would have benefitted from active surveillance and/or pretreatment biopsy.
CONCLUSIONS: Surgeon-reviewers identified moderate/major opportunities for QI in 33 patients that underwent RN who may have been spared from kidney loss. Kidney loss can be prevented by considering active surveillance, confirmatory imaging, renal mass biopsy, and/or kidney-sparing interventions in patients with T1aRM, low/intermediate complexity T1bRM, young patients, and patients with CKD.