Renal cancer surgery is frequently performed in small regional hospitals in Japan. This study evaluated the outcomes of renal cancer surgery, comparing results from the pre-robotic surgery era with those obtained with robotic surgery.
This prospective cohort study was conducted on patients who underwent renal cancer surgery between 2008 and 2013 at 14 hospitals, comprising 13 regional hospitals and a university hospital, registered in the Tohoku Urological Evidence-Based Medicine Study Group. The patients' backgrounds; perioperative data; annual postoperative renal function; and prognostic surveys, performed over a median follow-up period of 10 years were obtained.
In 930 surgical cases at the 14 registered hospitals, the 10-year recurrence-free survival rates of cT1a, cT1b, cT2, and cT3 were 0.9326, 0.8501, 0.5786, and 0.5101, respectively. Meanwhile, the 10-year overall survival rates were 0.9612, 0.8662, 0.7505, and 0.7209, respectively. Long-term observation in patients with cT1 showed that vessel involvement and high tumor grade were prognostic factors for recurrence. As a noteworthy fact, radical nephrectomy was performed in 53.3% of patients with cT1a at the regional hospitals. However, even in patients with preoperative chronic kidney disease stage 3, radical nephrectomy was not a prognostic factor of renal function. This indicates that compensatory mechanisms had been working for a long time in many patients who underwent radical nephrectomies without hypertension and preoperative proteinuria, which were predictors of end-stage renal disease.
Based on a prospective long-term survey of the pre-robotic era, our results suggested no difference of the survival outcomes between the university hospital and regional hospitals. Our study provides baseline data to evaluate the outcomes of renal cancer robotic surgery, performed at regional hospitals.
International urology and nephrology. 2023 Feb 13 [Epub ahead of print]
Yoshihide Kawasaki, Hideo Saito, Naomasa Ioritani, Tatsuo Tochigi, Isamu Numata, Kenji Numahata, Fumihiko Soma, Atsushi Kyan, Shigeto Ishidoya, Shozo Ota, Takashige Namima, Kazuhiko Orikasa, Shinichi Yamashita, Koji Mitsuzuka, Yoichi Arai, Akihiro Ito
Tohoku Urological Evidence-Based Medicine Study Group, Japan (Japan Community Health Care Organization Sendai Hospital, Miyagi Cancer Center, Osaki Citizen Hospital, Yamagata Prefectural Central Hospital, Hachinohe City Hospital, Shirakawa Kosei General Hospital, Sendai City Hospital, Sendai Red Cross Hospital, Tohoku Rosai Hospital, Kesennuma City Hospital, Sen-en Rifu Hospital, Iwate Prefectural Iwai Hospital, KKR Tohoku Kosai Hospital, and Tohoku University Hospital), Sendai, Japan. ., Tohoku Urological Evidence-Based Medicine Study Group, Japan (Japan Community Health Care Organization Sendai Hospital, Miyagi Cancer Center, Osaki Citizen Hospital, Yamagata Prefectural Central Hospital, Hachinohe City Hospital, Shirakawa Kosei General Hospital, Sendai City Hospital, Sendai Red Cross Hospital, Tohoku Rosai Hospital, Kesennuma City Hospital, Sen-en Rifu Hospital, Iwate Prefectural Iwai Hospital, KKR Tohoku Kosai Hospital, and Tohoku University Hospital), Sendai, Japan.