Surgical management of stage T1 XXXX at Canadian academic centres.

@entity1 @entity101 @entity5 @entity703
INTRODUCTION: The proportion of @entity1 with stage 1 @entity703 receiving partial nephrectomy is considered a quality of care indicator. The objective of this study was to characterize surgical practice patterns at Canadian academic institutions for the treatment of these @entity5 . METHODS: The @entity703 ( @entity703 ) is a multicentre collaboration of 13 academic institutions in Canada. All @entity1 with pathologic stage T1 @entity703 in @entity703 were identified. Descriptive statistics were performed to characterize practice patterns over time. Associations between @entity1 , @entity5 , and treatment factors with the use of partial nephrectomy were determined. RESULTS: From 1988 to April 2014, 1453 @entity1 with pathologic stage 1 @entity703 were entered in the @entity703 database. Of these, 977 (67%) @entity1 had pT1a @entity5 ; of these, 765 (78%) received partial nephrectomy. Of the total number of @entity1 (1453), 476 (33%) had pT1b @entity5 ; of these, 204 (43%) received partial nephrectomy. The use of partial nephrectomy increased over time from 60% to 90% for pT1a @entity5 and 20% to 60% for pT1b @entity5 . Stage pT1b (relative risk [RR] 0.56, 95% confidence interval [CI] 0.50-0.63) and minimally invasive surgical approach (RR 0.78, 95% CI 0.73-0.84 for pT1a and RR 0.23, 95% CI 0.17-0.30 for pT1b) were associated with decreased use of partial nephrectomy. Most @entity1 factors including age, gender, body mass index, @entity101 , and renal function were not significantly associated with use of partial nephrectomy (p > 0.05). CONCLUSION: Almost all pT1a and most pT1b @entity703 managed surgically at academic centres in Canada receive partial nephrectomy. The use of partial versus radical nephrectomy appears to occur independently of @entity1 age and comorbid status, which may indicate that urologists are performing partial nephrectomy whenever technically feasible based on @entity5 factors. Although the ideal proportion @entity1 receiving partial nephrectomy cannot be determined, treatment distribution observed in this cohort may indicate an achievable case distribution among experienced surgeons.
