Abstract Background Radical nephrectomy with inferior vena cava thrombectomy (RN-IVCT) is a complicated procedure for which the impact of hospital case volume on overall survival (OS) is unknown. Objective To assess the degree to which renal cell carcinoma (RCC) with inferior vena cava tumor thrombus (IVC-TT) care is centralized and to evaluate the impact of hospital case volume on outcomes following RN-IVCT. Design, setting, and participants The National Cancer Data Base was queried for patients with pT3b–c RCC treated with RN-IVCT. Hospitals were classified by case volume percentile as low ( 95th percentile, >3 cases annually). Outcome measurements and statistical analysis The primary outcome was OS. Secondary outcomes were short-term (30- and 90-d) mortality rates according to hospital case volume. Kaplan-Meier curves and Cox regression model were used to evaluate OS and the effect of covariables. Results and limitations There were 2664 cases of RN-IVCT for pT3b–c tumors reported by 573 institutions, of which 435, 108, and 30 were classified as low, intermediate, and high volume, accounting for 28.5%, 34.5%, and 37% of cases, respectively. Treatment at high-volume institutions was associated with better OS: the median OS was 42, 53, and 60 months for low, intermediate and high-volume centers, respectively (p=0.009). After multivariable adjustment, treatment at a high-volume institution was associated with a 24% relative risk reduction for all-cause mortality compared to treatment at a low-volume institution (hazard ratio 0.76, 95% confidence interval 0.65–0.89; p=0.001). There was no significant difference in short-term mortality following RN-IVCT when stratified by hospital case volume. Conclusions Higher hospital case volume was associated with longer OS for patients undergoing RN-IVCT. These findings support efforts to centralize care for cases of advanced RCC. Patient summary In this study we looked at the impact of hospital case volume on survival following surgery for renal cell carcinoma and inferior vena cava thrombectomy. Survival was significantly better in high-volume hospitals performing three or more procedures per year.
Abstract Background Higher treatment facility (TF) volume has been linked with improved oncologic treatment outcomes. Objective To determine the association between TF volume and overall survival in patients with metastatic renal cell carcinoma (mRCC). Design, setting, and participants The National Cancer Database (NCDB) was queried for all patients with mRCC with survival data available (2004–2013, cohort A). Overall survival was assessed based on TF volumes, and increasingly narrow inclusion c...
Last. Ahmedin Jemal(ACS: American Cancer Society)H-Index: 139
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Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data, available through 2014, were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data, available through 2015, were collected by the Nation...
Abstract Background Given the rarity of testicular germ cell tumors (TGCTs) and the complex aspects of management, we evaluate the effect of hospital TGCT case volume on overall survival outcomes and practice patterns. Materials and methods The National Cancer Database was queried for patients diagnosed with seminoma or nonseminomatous germ cell tumor (NSGCT). Hospitals were classified by case volume as high (99th percentile, ≥26.1 cases annually), high-intermediate (95–99th percentile, 14.6–26....
Last. Christopher Evans(UC Davis: University of California, Davis)H-Index: 11
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Abstract Objectives To study the effect of lymph node dissection (LND) at the time of nephrectomy and tumor thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumor thrombus. Patients and Methods The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1985 to 2014 at 24 centers were analyzed. None of the patients had distant metastases. Extent and pathologic results of LND were compared with respect...
#1Michael Lardas(ARI: Aberdeen Royal Infirmary)H-Index: 10
#2Fiona Stewart(Aberd.: University of Aberdeen)H-Index: 36
Last. Thomas B. Lam(Aberd.: University of Aberdeen)H-Index: 42
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Overall, 4-10% of patients with renal cell carcinoma (RCC) present with venous tumour thrombus. It is uncertain which surgical technique is best for these patients. Appraisal of outcomes with differing techniques would guide practice.
#1Ahmed Q. Haddad(UTSW: University of Texas Southwestern Medical Center)H-Index: 15
#2Bradley C. Leibovich(UTSW: University of Texas Southwestern Medical Center)H-Index: 89
Last. Vitaly Margulis(UTSW: University of Texas Southwestern Medical Center)H-Index: 40
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Objective Surgical resection for renal cell carcinoma (RCC) with suprahepatic inferior vena cava tumor thrombus is associated with significant morbidity, yet there are currently no tools for preoperative prognostic evaluation. Our goal was to develop a preoperative multivariable model for prediction of survival and risk of major complications in patients with suprahepatic thrombi. Methods We identified patients who underwent surgery for RCC with suprahepatic tumor thrombus extension from 2000 to...
Purpose: Suprahepatic inferior vena caval tumor thrombus in renal cell carcinoma cases has historically portended a poor prognosis. With advances in perioperative treatment of patients with high level thrombus contemporary outcomes are hypothesized to be improved. We evaluated long-term oncologic outcomes of contemporary surgical treatment of patients with renal cell carcinoma in whom level III-IV inferior vena caval thrombus was managed at high volume centers.Materials and Methods: We examined ...
Objective To test whether the number of lymph nodes removed affects cancer-specific survival (CSS) or metastatic progression-free survival (MPFS) in different renal cell carcinoma (RCC) scenarios. Methods We used Cox regression analyses to analyse the effect of the number of lymph nodes removed on CSS and MPFS in 1983 patients with RCC treated with nephrectomy. To adjust for possible clinical and surgical selection bias, analyses were further adjusted for number of positive nodes, presence of me...
Last. Amir A. Ghaferi(UM: University of Michigan)H-Index: 31
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Importance To effectively guide interventions aimed at reducing mortality in low-volume hospitals, the underlying mechanisms of the volume-outcome relationship must be further explored. Reducing mortality after major postoperative complications may represent one point along the continuum of patient care that could significantly affect overall hospital mortality. Objective To determine whether increased mortality at low-volume hospitals performing cardiovascular surgery is a function of higher po...
Objective To determine whether surgeon or hospital volume effects in-hospital mortality or complications of radical nephrectomy with concomitant removal of inferior vena cava (IVC) thrombus, we examine a national population-based cohort. Radical nephrectomy with removal of IVC thrombus is a complex urologic operation, which, similar to other major surgical procedures, may have an association between provider volume and outcomes. Methods Canadian Institute for Health Information administrative co...
#1Vitaly Margulis(UTSW: University of Texas Southwestern Medical Center)H-Index: 40
#2Yuval Freifeld(UTSW: University of Texas Southwestern Medical Center)H-Index: 6
Last. Raquibul Hannan(UTSW: University of Texas Southwestern Medical Center)H-Index: 19
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Abstract Purpose To evaluate the feasibility, safety, oncological outcomes and immune effect of neoadjuvant stereotactic radiation (Neo-SAbR) followed by radical nephrectomy and thrombectomy (RN-IVCT). Methods and Materials These are results from the safety lead-in portion of a single arm phase I-II trial. Patients with kidney cancer (RCC) and IVC tumor thrombus (IVC-TT) underwent Neo-SAbR (40 Gy in 5 fractions) of the IVC-TT followed by open RN-IVCT. Absence of grade 4-5 adverse events (AEs) wi...
Abstract There are considerable disparities between the quality of cancer care and clinical outcomes for cancer patients in different European countries, regions, hospitals and communities. These have persisted despite the introduction of many European and National Cancer Plans, an extensive portfolio of clinical guidelines and the existence of evidence based guidelines for the good practice in planning cancer healthcare systems. We describe the European Code of Cancer Practice which is a citize...
#1Julia Wainger(JHUSOM: Johns Hopkins University School of Medicine)H-Index: 1
#2Joseph G. Cheaib(JHUSOM: Johns Hopkins University School of Medicine)H-Index: 5
Last. Phillip M. Pierorazio(JHUSOM: Johns Hopkins University School of Medicine)H-Index: 42
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PURPOSE Provider and hospital factors influence healthcare quality, but data are lacking to assess their impact on renal cancer surgery. We aimed to assess factors related to surgeon and hospital volume and study their impact on 30-day outcomes after radical nephrectomy. MATERIALS AND METHODS Renal surgery data were abstracted from Maryland's Health Service Cost Review Commission from 2000 to 2018. Patients ≤18 years old, without a diagnosis of renal cancer, and concurrently receiving another ma...
OBJECTIVE To examine the association between hospital volume and postoperative 5-year survival for patients with prostate, kidney, and bladder cancer. METHOD Using Osaka Cancer Registry data, we identified 9285 patients who were diagnosed as having prostate, kidney, or bladder cancer and who underwent surgery between 2007 and 2011 in Osaka, Japan. The surgical hospital volume of each hospital was calculated and then divided into quartiles (high, medium, low, very low). We estimated the hazard ra...
#1Alireza Ghoreifi(SC: University of Southern California)H-Index: 7
#2Hooman Djaladat(SC: University of Southern California)H-Index: 23
Purpose of review The aim of this review is to describe the preoperative evaluation, surgical techniques, and postoperative management of patients with renal cell carcinoma (RCC) undergoing radical nephrectomy (RN) and inferior vena cava (IVC) thrombectomy. Recent findings RN and IVC thrombectomy remains the standard management option in non-metastatic RCC patients with IVC thrombus. A comprehensive preoperative workup, including high-quality imaging, blood works, and appropriate consultations a...
Sinds de introductie van minimaal-invasieve chirurgie (MIS) in de jaren ‘90 van de vorige eeuw heeft de nierchirurgie een enorme vlucht genomen. Na de eerste laparoscopische nefrectomie in 1990 door Ralph Clayman volgde in 2001 de eerste robotgeassisteerde nefrectomie door Bertrand Guillonneau. Inmiddels wordt in Nederland de nierchirurgie grotendeels minimaal-invasief uitgevoerd.
#2Riccardo Campi(UniFI: University of Florence)H-Index: 17
Last. Maarten Albersen(Katholieke Universiteit Leuven)H-Index: 26
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Abstract Background Cytoreductive nephrectomy (CN) plays an important role in the treatment of a subgroup of metastatic renal cell carcinoma (mRCC) patients. Objective We aimed to evaluate morbidity associated with this procedure and identify potential predictors thereof to aid patient selection for this procedure and potentially improve patient outcomes. Design, setting, and participants Data from 736 mRCC patients undergoing CN at 14 institutions were retrospectively recorded in the Registry f...