Changes in the UK renal oncologic surgical practice from 2008 to 2017: implications on cancer service provision and surgical training.

To determine and analyse the temporal changes in oncologic nephrectomy practice and training opportunities using data obtained from the UK BAUS nephrectomy register from 2008 to 2017.

All nephrectomies within the dataset for this time period were analysed (n = 54251). Cases were divided into radical nephrectomy (RN), partial nephrectomy (PN) and nephroureterectomy (NU). Simple nephrectomy (SN), donor nephrectomy and benign PN were excluded. The annual frequency for each oncologic nephrectomy modality, surgical approach, grade of surgeon, hospital caseload numbers and short-term surgical outcomes were determined.

Reported annual nephrectomy numbers increased by 2.5 fold in the nine-year time period. The number of hospitals performing nephrectomies decreased by 22%, however over 40% of centres performed more than 70 cases a year. There was a trend towards a decrease in overall length of hospital stay (9 vs 5 days (p <0.01)) and decreased transfusion rates. The proportion of minimally invasive procedures increased from 57% to 75%, with nephron-sparing rates increasing from 8.9% overall to 24.8%. With regards to surgical technique, robot-assisted surgery saw a mean annual increase of 222%. Overall there was a 10% decrease in the proportion of PNs performed by trainee surgeons.

Renal surgery has changed considerably with regards to volume and also surgical approach, with nephron sparing surgery (NSS) and minimally invasive surgery (MIS) significantly increasing. Increasing hospital centralisation, institutional experience and a shift to robot-assisted surgery appear to have contributed to the observed improved patient outcomes. With increasing utilisation of robot-assisted surgery, this has potential implications and challenges for the training of future urology surgeons.

BJU international. 2020 Nov 29 [Epub ahead of print]

Conor M Devlin, Sarah Fowler, Chandra Shekhar Biyani, James A Forster

Urology department, Bradford Royal Infirmary, Bradford teaching hospitals foundation trust, Duckworth lane, Bradford, West Yorkshire, BD9 6RJ, UK., British Association of Urological Surgeons, 35-43 Lincoln's Inn Fields, London, WC2A 3PE., Department of Urology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK.

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