@article{a689ef7837a74b778bc0dcddeb0ea9bc,
title = "Nephron-sparing surgery across a nation - outcomes from the British Association of Urological Surgeons 2012 national partial nephrectomy audit",
abstract = "Objective: To determine the scope and outcomes of nephron-sparing surgery (NSS), i.e. partial nephrectomy, across the UK and in so doing set a realistic benchmark and identify fresh contemporary challenges in NSS. Patients and Methods: In 2012 reporting of outcomes of all types of nephrectomy became mandatory in the UK. In all, 148 surgeons in 86 centres prospectively entered data on 6 042 nephrectomies undertaken in 2012. This study is a retrospective analysis of the NSS procedures in the dataset. Results: A total of 1 044 NSS procedures were recorded and the median (range) surgical volume was 4 (1-39) per consultant and 8 (1-59) per centre. In all, 36 surgeons and 10 centres reported on only one NSS. The indications for NSS were: elective with a tumour of ≤4.5 cm in 59%, elective with a tumour of >4.5 cm in 10%, relative in 7%, imperative in 12%, Von Hippel-Lindau in 1%, and unknown in 11%. The median (range) tumour size was 3.4 (0.8-30) cm. The technique used was minimally invasive surgery in 42%, open in 58%, with conversions in 4%. The histology results were: malignant in 80%, benign in 18%, and unknown in 2%. In patients aged <40 years 36% (36/101) had benign histology vs 17% (151/874) of those aged ≥40 years (P < 0.01). In patients with tumours of <2.5 cm 29% (69/238) had benign histology vs 14% (57/410) with tumours of 2.5-4 cm vs 8% (16/194) with tumours of ≥4 cm (P = 0.02). In patients aged <40 years with of tumours of <2.5 cm 44% (15/34) were benign. The 30-day mortality was 0.1% (1/1 044). There were major complications (Clavien-Dindo grade of ≥IIIa) in 5% (53/1 044). There was an increased risk of complications after extended elective NSS of 19% (19/101) vs elective at 12% (76/621) (relative risk [RR] 1.54; P < 0.01). Margins were recorded in 68% (709/1 044) of the patients, with positive margins identified in 7% (51/709). Positive surgical margins after NSS for pathological T3 (pT3) tumours were found in 47.8% (11/23) vs 6.1% (32/523) for pT1a, tumours (RR 5.61; P < 0.01). In all, 14% (894/6 042) of the patients underwent surgery for T1a tumours: 55% (488/894) by NSS, 42% (377/894) by radical nephrectomy (RN), and in 3% (29/894) the procedure used was unknown. Major complications after occurred in 4.9% (24/488) of NSS vs 1.3% (5/377) of RN (P < 0.01). Limitations included poor reporting of renal function data and no data on tumour complexity. Conclusions: In its first year, mandatory national reporting has provided several challenging contemporary insights into NSS.",
keywords = "nephron-sparing surgery, partial nephrectomy, national audit, renal cancer, complications",
author = "Archie Fernando and Sarah Fowler and Tim O'Brien and {The British Association of Urological Surgeons (BAUS)} and Z. Abbasi and Adamson, {A. S.} and Addla, {S. K.} and Adeyoju, {A. A.} and Adshead, {J. M.} and N. Afzal and Aho, {T. F.} and M. Akhtar and M. Al-Akraa and M. Al-Sudani and J. Allan and Almond, {D. J.} and Anderson, {C. J.} and Andrews, {S. J.} and I. Apakama and T. Armitage and J. Armitage and N. Awsare and B. Ayres and Banerjee, {G. K.} and Barber, {N. J.} and Barua, {J. M.} and S. Basu and Bdesha, {A. S.} and Beacock, {C. J M} and J. Beatty and {O Beck}, R. and M. Belal and Bell, {C. R W} and Bhanot, {S. M.} and R. Bhatt and Biyani, {C. S.} and Blades, {R. A.} and C. Blake and B. Blake-James and J. Boddy and Bromage, {S. J.} and E. Bromwich and C. Brown and Browning, {A. J.} and Bryan, {N. P.} and Burgess, {N. A.} and N. Burns-Cox and Butterworth, {P. C.} and J. Bycroft and Calleary, {J. G.} and Calvert, {R. C.} and I. Campbell and Campbell, {C. A.} and A. Cannon and Carter, {P. G.} and Carter, {C. J M} and Cartledge, {J. J.} and R. Casey and A. Chakravarti and B. Challacombe and S. Chandrasekharan and Chappell, {B. G.} and Chen, {T. F.} and J. Cherian and Choi, {W. H.} and K. Chow and {Clavijo Eisele}, J. and Cliff, {A. M.} and Cohen, {N. P.} and Cole, {O. J.} and J. Collins and S. Connolly and Cooke, {P. W.} and G. Cooksey and Cornaby, {A. J.} and Cornford, {P. A.} and Corr, {J. G.} and R. Coulthard and Cranston, {D. W.} and J. Cresswell and Crundwell, {M. C.} and Cutinha, {P. E.} and M. Cynk and Daruwala, {P. D.} and P. Dasgupta and Datta, {S. N.} and K. Davenport and E. Bolla and R. Devarajan and Dickerson, {D. A G} and Dickinson, {A. J.} and Doherty, {A. P.} and Donaldson, {P. J.} and T. Dudderidge and J. Dyer and J. Eaton and B. Eddy and Eden, {C. G.} and M. Elsaghir and Evans, {S. D.} and R. Fiala and Fordham, {M. V. P.} and Foster, {M. C.} and French, {A. J.} and Frymann, {R. J.} and Gall, {Z. J.} and Gallegos, {C. R. R.} and Gana, {H. B. Y.} and S. Garnett and M. Ghei and N. Gibbons and Gilbert, {H. W.} and Gillatt, {D. A.} and Godbole, {H. C.} and A. Golash and Goodman, {C. M.} and B. Gowardhan and Green, {J. S. A.} and Griffiths, {T. R. L.} and S. Gujral and T. Gunendran and Hagan, {C. M.} and N. Haldar and Hanbury, {D. C.} and J. Harney and Hasan, {S. T.} and Hawkyard, {S. J.} and Hayes, {M. C.} and Haynes, {M. D.} and A. Henderson and Hicks, {J. A.} and Hindley, {R. G.} and Hodgson, {D. J.} and M. Hotston and Howell, {G. P.} and D. Hrouda and Hughes, {O. D. M.} and P. Hunter-Campbell and C. Ilie and R. Issa and S. Jain and A. Jain and Janjua, {K. S.} and P. Javle and P. Johnson and Johnson, {M. I.} and A. Jones and H. Joshi and Joyce, {A. D.} and S. Kanaga-Sundaram and Karim, {O. M. A.} and Keeley, {F. X.} and A. Kelkar and Kelleher, {J. P.} and Khattak, {A. Q.} and B. Khoubehi and M. Kimuli and Kirollos, {M. M.} and Kockelbergh, {R. C.} and G. Kooiman and A. Koupparis and P. Kumar and Kynaston, {H. G.} and Laniado, {M. E.} and T. Larner and Z. Latif and Lau, {M. W.} and E. Roux and S. Leung and J. Leveckis and G. Lewis and Liston, {T. G.} and Lockyer, {C. R. W.} and Lodge, {R. N.} and Luscombe, {C. J.} and M. Lynch and C. Lynch and Lynn, {N. N K} and Macdermott, {J. P.} and S. Mackie and S. Madaan and Maddineni, {S. B.} and P. Maheshkumar and Makar, {A. A.} and Makunde, {J. T.} and R. Manikandan and Mann, {G. S.} and M. Mantle and Mark, {I. R.} and Matanhelia, {S. S.} and J. McCabe and S. McClinton and McFarlane, {J. P.} and McInerney, {P. D.} and McIntyre, {I. G.} and E. McLarty and McLornan, {M. E.} and J. McLoughlin and McNeill, {S. A.} and S. Mehta and Mellon, {J. K.} and P. Menezes and Mills, {R. D.} and M. Mokete and R. Montague and Morton, {A. L.} and Motiwala, {H. G.} and Mulholland, {C. K.} and Mumtaz, {F. H.} and N. Munro and A. Myatt and M. Nair and S. Namasivayam and Napier-Hemy, {R. D.} and S. Nathan and D. Neilson and Nicol, {D. L.} and M. Nuttall and O'Kane, {H. F.} and A. O'Riordan and G. Oades and N. Oakley and Okeke, {A. A.} and J. Olsburgh and E. Paez and T. Page and J. Parkin and Parys, {B. T.} and P. Patel and N. Patel and B. Patel and S. Pathak and K. Patil and Paul, {A. B.} and D. Payne and Peracha, {A. M.} and Peters, {J. L.} and Phillips, {S. M. A.} and Phillips, {J. T.} and S. Phipps and Pillai, {M. K.} and Potter, {J. M.} and S. Prescott and Rajan, {T. N.} and P. Rajjayabun and Ramani, {V. A C} and A. Rane and R. Ravi and S. Ravichandran and Richmond, {P. J M} and Riddick, {A. C P}",
year = "2016",
month = jun,
day = "1",
doi = "10.1111/bju.13353",
language = "English",
volume = "117",
pages = "874--882",
journal = "BJU international",
issn = "1464-4096",
publisher = "Wiley-Blackwell, Wiley",
number = "6",
}