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- Title
The impact of robotic surgery access on the management of patients with clinical stage I kidney tumors.
- Authors
Lemire, Francis; MengQi Zhang; Anderson, Patrick; Finelli, Antonio; Rendon, Ricardo A.; Tanguay, Simon; Bansal, Rahul; Bhindi, Bimal; So, Alan I.; Pouliot, Fre'de'ric; Dean, Lucas; Mallick, Ranjeeta; Lavallée, Luke T.; Breau, Rodney H.
- Abstract
INTRODUCTION: Robotic surgery is used in the treatment of kidney tumors. We aimed to determine if robotic access was associated with initial choice of management for patients with a clinical stage I kidney mass. METHODS: Patients with a clinical stage I kidney mass were identified from the Canadian Kidney Cancer information system (CKCis) cohort. Sites were classified by year and access to robotic surgery. Associations between robotic access and initial management were determined using logistic regression. Univariable and multivariable analyses were performed, adjusting for tumor size and stage, and presented as relative risks (RR) or adjusted RR (aRR) and 95% confidence intervals (CI). RESULTS: Overall, 4160 patients were included. Among patients treated with surgery, the proportion of partial nephrectomy compared to radical nephrectomy was significantly higher in robotic sites (77.3% for robotic sites vs. 65.9% for non-robotic sites; RR 1.17, 95% CI 1.12-1.23, p<0.0001; aRR 1.12, 95% CI 1.08-1.17, p<0.0001). Patients receiving partial nephrectomy at sites with robotic access were more likely to receive a minimally invasive approach compared to patients at non-robotic sites (61.4% vs. 50.9%, RR 1.21, 95% CI 1.12-1.30; aRR 1.16, 95% CI 1.08-1.25, p<0.0001). The proportion of patients managed by active surveillance was not significantly different between robotic (405, 16.9%) and nonrobotic (258, 14.7%) sites (RR 1.15, 95% CI 0.99-1.32; aRR 0.97, 95% CI 0.84-1.12). CONCLUSIONS: Access to robotic kidney surgery was associated with increased use of partial nephrectomy and minimally invasive partial nephrectomy. Use of active surveillance was similar at robotic and non-robotic institutions. Limitations of this study include lack of data on perioperative complications and cancer recurrence.
- Subjects
CANADA; STATISTICS; RELATIVE medical risk; NEPHRECTOMY; HEALTH services accessibility; ACADEMIC medical centers; CONFIDENCE intervals; SURGICAL robots; MULTIVARIATE analysis; MINIMALLY invasive procedures; CONTINUING education units; TREATMENT effectiveness; MEDICAL care use; KIDNEY tumors; DESCRIPTIVE statistics; RESEARCH funding; LOGISTIC regression analysis; LONGITUDINAL method; EVALUATION
- Publication
Canadian Urological Association Journal, 2024, Vol 18, Issue 2, p55
- ISSN
1911-6470
- Publication type
Article
- DOI
10.5489/cuaj.8506