Introduction: Rapid adoption of robotics has introduced a paradigm change in prostate cancer treatment, with more than 80% of prostatectomies performed robotically in 2015. For treatment of renal cell carcinoma (RCC), this change has not previously been reported. We evaluated trends in surgical management of RCC in Kaiser Permanente Southern California (KPSC) within the last 16 years, especially after adoption of robotics.
Methods: From January 1999 to September 2015, all KPSC members who underwent surgical treatment of suspected RCC were included retrospectively. Surgical approach, patient age, sex, clinicopathology, Charlson Comorbidity Index, and chronic kidney disease status were analyzed using robust Poisson multivariate regression.
Results: The study included 5237 patients. Partial nephrectomy was increasingly used during the study period, and its use surpassed radical nephrectomy in 2012. In a multivariate model, partial nephrectomy was associated with lower pathologic tumor stage (p < 0.001) and lower Charlson Comorbidity Index (p = 0.004) vs radical nephrectomy. Robot-assisted laparoscopic partial nephrectomy (RALPN) started in KPSC in March 2011, and its relative use among all RCC surgeries increased in the following 3 years by 125%, 45%, and 14%. Laparoscopic partial nephrectomy and laparoscopic radical nephrectomy were the most frequently used surgical approaches for localized RCC when RALPN started in 2011. However, RALPN surpassed laparoscopic partial nephrectomy and laparoscopic radical nephrectomy in 2012 and 2014, respectively.
Conclusion: During our study, partial nephrectomy became the most common surgery for treatment of localized RCC. Since 2014, RALPN has become the most common renal oncologic surgical modality in KPSC.