Trends in the use of of nephron-sparing surgery (NSS) at an Australian tertiary referral centre: An analysis of surgical decision-making using the R.E.N.A.L. nephrometry scoring system

OBJECTIVE: • To examine recent trends in the use of nephron-sparing surgery (NSS) at our centre. Specifi cally, we sought to examine the process of surgical decision-making by applying the R.E.N.A.L. nephrometry scoring system to assess the complexity of lesions for which surgery was undertaken. PATIENTS AND METHODS: • We performed a retrospective review of renal masses treated by surgery from January 2005 to December 2009, including 79 RN and 70 NSS. • CT images were available for analysis in 50 patients within each group. • Lesions were scored on the basis of their complexity using the R.E.N.A.L. nephrometry scoring system developed by Kutikov and Uzzo. RESULTS: • There was no difference in age between patients undergoing RN and NSS (median age 61 vs 60 years). • RN was performed for significantly larger lesions (mean [sd] 68 [9] vs 29 [2] mm, P < 0.05) of predominantly moderate and high complexity (12% low, 56% moderate, 32% high). • NSS was primarily used for low-complexity lesions, but included four (8%) moderate-complexity lesions in the final 2 years of the study. • The use of NSS increased from 28.6% of cases in 2005 to 60.0% of cases in 2009, which mirrored the increase in the proportion of operations performed for low-complexity lesions (22.2% lowcomplexity in 2005 to 70.6% in 2009, P < 0.01 for trend). CONCLUSIONS: • The increasing use of NSS at our institution mirrored the increasing treatment of low-complexity renal lesions. • This may refl ect an increased detection and referral of such lesions, or a shift towards treatment of lesions that in the past would have been under surveillance. • Practice at our centre refl ects a shifting paradigm towards preferential use of NSS for the treatment of suitable renal masses.