According to international guidelines, partial nephrectomy is recommended as the standard of care in patients with cT1 kidney tumours, as well as in those with cT2, whenever technically feasible. Furthermore, due to the numerous advantages of minimally invasive techniques, the laparoscopic approach has been increasingly used worldwide. Our aim was to investigate the evolution of kidney surgery and to evaluate whether urologists adhere to these guidelines. Furthermore, we assessed the uptake of minimally invasive techniques in Switzerland over the past decade (observational period 2008-2020).
Datasets were provided by the National Agency for Cancer Registration (NACR) and the Swiss Federal Statistical Office (FSO). The national cancer registry dataset was used to analyse age categories, gender, demographics, year of intervention, T-stage, and which surgical method (partial vs radical nephrectomy) was performed as the primary outcome. The data from FSO included information on the surgical approach (laparoscopic vs open) as the secondary outcome, including mortality. The age-standardised incidence rate (ASIR) was computed per 100,000 population, standardised to the European Standard Population. This study was conducted as an exploratory retrospective analysis, and results should be interpreted within this framework. Statistical analysis was performed using R.
The national cancer registry dataset included 10,810 patients with kidney tumours from 2008 to 2020. During this period, the ASIR (age-standardised incidence rate) of kidney tumours in Switzerland increased more than threefold, from 3.0 to 9.6 cases per 100,000 population. A total of 6,565 patients (60.7%) with kidney tumours were included in the analysis. The highest incidence of surgical treatment occurred among patients aged 65-69 (n = 1,081). However, during the observation period, cancer registration coverage of the Swiss population increased from 60% in 2008 to 100% in 2020. As the primary outcome, the relative number of partial versus radical nephrectomy overall increased from 23.2% (n = 48) in 2008 to 48.0% (n = 393) in 2020. In patients with pT1 tumours, a total of 2,457 partial nephrectomies (59.6%) were performed compared with 1,667 radical nephrectomies (40.4%) during the observation period. The FSO dataset included 10,700 patients with kidney tumours between 2008 and 2018. As the secondary outcome, the ratio of laparoscopic procedures compared with open procedures increased from 21.1% (n = 194) in 2011 to 45.2% (n = 485) in 2018. Regional differences were identified, especially regarding the relative number of partial nephrectomy procedures performed. Although the T-stage distribution at the time of diagnosis did not differ between genders, a slightly higher proportion of men (43.0%, n = 4,669) underwent partial nephrectomy compared to women (40.6%, n = 1'896). Overall mortality was low, with 0.7% in partial nephrectomy (n = 13) versus 1.3% in radical nephrectomy (n = 96) procedures, regardless of the surgical method.
Our study highlights a distinct increase in laparoscopic surgery (presumably robot-assisted) and partial nephrectomy for the treatment of kidney tumours during the past decade in Switzerland, suggesting adequate adherence to international guidelines. Further research is needed to analyse demographic and regional differences.
Swiss medical weekly. 2026 Jun 03*** epublish ***
Florian A Schmid, Luca Schütz, Marcel Blum, Lea Wildisen, Katharina Staehelin, Mohsen Mousavi, Thomas Paul Scherer, Räto T Strebel
Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland., Cancer Registry of Eastern Switzerland, St. Gallen, Switzerland., National Institute for Cancer Epidemiology and Registration (NICER), Zurich, Switzerland., Department of Urology, Kantonsspital Graubünden, Chur, Switzerland.