Background: We aimed to evaluate the current trends in renal cancer surgery, as well as to compare the perioperative outcomes of partial versus radical nephrectomy. Methods: We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2005–2021). We report the largest study in the field, with 317,843 patients and multiple patient-level analyses. Results: Overall, 123,924 (39%) patients underwent partial and 193,919 (61%) underwent radical nephrectomy in Germany from 2005 to 2021. Of them, 57,308 (18%) were operated on in low-, 142,702 (45%) in intermediate-, and 117,833 (37%) in high-volume centers. A total of 249,333 (78%) patients underwent open, 44,994 (14%) laparoscopic, and 23,516 (8%) robotic nephrectomy. The number of patients undergoing renal surgery remained relatively stable from 2005 to 2021. Over the study period, the utilization of partial nephrectomy increased threefold, while radical nephrectomy decreased by about 40%. After adjusting for major risk factors in the multivariate regression analysis, radical nephrectomy was associated with 3.2-fold higher odds (95% CI: 3.2 to 3.9,p< 0.001) of 30-day mortality, longer hospitalization by 1.9 days (95% CI: 1.9 to 2,p< 0.001), and higher inpatient costs by EUR 1778 (95% CI: 1694 to 1862,p< 0.001) compared to partial nephrectomy. Furthermore, radical nephrectomy had a higher risk of in-hospital transfusion (p< 0.001), sepsis (p< 0.001), acute respiratory failure (p< 0.001), acute kidney disease (p< 0.001), acute thromboembolism (p< 0.001), surgical wound infection (p< 0.001), ileus (p< 0.001), intensive care unit admission (p< 0.001), and pancreatitis (p< 0.001). Conclusions: More patients are offered partial nephrectomy in Germany. Patients undergoing radical nephrectomy present with a higher rate of concomitant risk factors and have increased perioperative morbidity and mortality, prolonged hospitalization, and increased in-hospital costs.
背景：本研究旨在评估当前肾癌手术的趋势，并比较肾部分切除术与根治性肾切除术的围手术期结果。方法：我们使用了由联邦统计局研究数据中心提供的德国全国住院患者数据（GRAND，2005-2021年）。本研究是该领域规模最大的研究，共纳入317,843例患者，并进行了多项患者层面的分析。结果：2005年至2021年期间，德国共有123,924例（39%）患者接受了肾部分切除术，193,919例（61%）患者接受了根治性肾切除术。其中，57,308例（18%）在低手术量中心、142,702例（45%）在中手术量中心、117,833例（37%）在高手术量中心接受手术。总计249,333例（78%）患者接受了开放手术，44,994例（14%）接受了腹腔镜手术，23,516例（8%）接受了机器人辅助肾切除术。2005年至2021年间，接受肾脏手术的患者数量保持相对稳定。在研究期间，肾部分切除术的使用率增加了三倍，而根治性肾切除术则下降了约40%。在多变量回归分析中调整主要风险因素后，与肾部分切除术相比，根治性肾切除术与30天死亡率升高3.2倍（95% CI: 3.2至3.9, p<0.001）、住院时间延长1.9天（95% CI: 1.9至2, p<0.001）以及住院费用增加1778欧元（95% CI: 1694至1862, p<0.001）相关。此外，根治性肾切除术具有更高的院内输血风险（p<0.001）、脓毒症风险（p<0.001）、急性呼吸衰竭风险（p<0.001）、急性肾脏疾病风险（p<0.001）、急性血栓栓塞风险（p<0.001）、手术伤口感染风险（p<0.001）、肠梗阻风险（p<0.001）、重症监护室入住风险（p<0.001）和胰腺炎风险（p<0.001）。结论：在德国，越来越多的患者接受肾部分切除术。接受根治性肾切除术的患者伴随风险因素的比例更高，并且围手术期发病率和死亡率增加，住院时间延长，住院费用也更高。
Surgical Trends and Complications in Partial and Radical Nephrectomy: Results from the GRAND Study
肿瘤(癌症)患者之家