Login to Access Video or Poster Abstract: MP55-20
Sources of Funding: none

Introduction

The rapid adoption of robotic surgery in the US has introduced a paradigm change, with over 80 percent of all prostatectomies for prostate cancer being performed robotically in 2015. For renal cancer, the trend has not been previously reported. We aim to evaluate the trend in surgical management of renal cancer in the last 8 years at Kaiser Permanente Southern California (KPSC).

Methods

From Jan 2008 to Dec 2015, all patients at KPSC who underwent surgical treatment for renal cancer were included retrospectively. Trends in surgical technique and approach, patients’ age, gender, clinicopathology, Charlson Comorbidity Index score, chronic kidney disease status were used to identify factors associated with the surgical technique using robust Poisson multivariate regression models.

Results

During this period 3163 patients were included. Robotic partial nephrectomy (PN) was approved by KPSC in March 2011, and its relative use amongst all renal cancer surgery increased by 125%, 45%, and 14% the following 3 years. Laparoscopic PN and laparoscopic radical nephrectomy (RN) were the most common surgeries, but decreased when robotic PN was introduced, and was surpassed by robotic PN in 2012 and 2014, respectively. In a multivariable model, use of partial nephrectomy was associated with lower pathologic T stage (p < 0.001) and lower Charlson Comorbidity Index score (p = .0037) compared with RN. Within subset analysis of partial nephrectomies performed from 2011-2015, minimally invasive approach was not associated with any of the considered covariates.

Conclusions

Since adoption in 2011, robotic PN has rapidly become the most common surgical modality to treat localized renal cancer. Further studies are necessary to understand the relationship between patient clinical data and surgical approach.

Funding

none