Surgeon caseload, practice type affect kidney Ca treatment

Patients with small kidney tumors are more likely to be offered treatment options based on surgeons’ case volume and type of practice than on tumor characteristics, suggests a study by researchers from Mayo Clinic, Rochester, MN.

Fellowship-trained surgeons who practice in academic medical centers with high volumes of patients with kidney tumors were 70% to 80% more likely to follow AUA guidelines by recommending partial nephrectomy. Surgeons in private practice who see few patients with kidney tumors more often offered radical nephrectomy.

"There is wide variability in how renal masses are managed. We must recognize these discrepancies may be due to different perceptions of technical feasibility in performing a partial nephrectomy," said first author Christopher Weight, MD, who worked on the study with Bradley Leibovich, MD, and colleagues. "What we’re encouraging is a discussion between physicians and patients about all options available. Some patients may benefit from a referral to surgeons with more experience with renal tumors."

The study showed that as kidney tumors get larger and more complex, all surgeons tend to offer a radical nephrectomy. However, the tumor complexity that may result in one surgeon recommending total removal of the kidney may be well below a more experienced surgeon’s threshold.