Our Summary

This research paper is about how the number of kidney surgeries (specifically, partial nephrectomies for kidney cancer) a hospital performs can affect the results of these surgeries. A team from the European Association of Urology reviewed ten different studies involving over 100,000 patients to see if there was any connection between the number of surgeries a hospital does and the outcomes for patients.

They found that hospitals that performed more of these surgeries tended to have lower complication rates, shorter hospital stays, fewer cases where cancer was left at the edge of the surgery site, and fewer patients needing blood transfusions. After adjusting for other factors, they found that hospitals that performed fewer surgeries had higher risks of complications, longer hospital stays, and were less likely to achieve a “trifecta” - no complications, a surgery time under 25 minutes, and no cancer left at the surgery site.

However, they also noted that most of the studies they looked at had a high risk of bias, so more research is needed. They suggest developing better ways of measuring surgery quality in kidney cancer care, so that high-quality centres can be identified and patients can be directed to them.

FAQs

  1. Does the number of kidney surgeries a hospital performs affect the results of the surgeries?
  2. What are the potential benefits of hospitals performing more partial nephrectomies for kidney cancer?
  3. What does the European Association of Urology suggest as a solution to improve kidney cancer care?

Doctor’s Tip

One helpful tip a doctor might tell a patient about nephrectomy is to choose a hospital that performs a higher number of kidney surgeries, as research suggests that hospitals with more experience tend to have better outcomes for patients undergoing nephrectomy. It is important to ask your healthcare provider about the hospital’s experience with nephrectomy and consider seeking care at a high-quality centre for better results.

Suitable For

Patients who are typically recommended for nephrectomy include those with:

  1. Kidney cancer (renal cell carcinoma): Nephrectomy is often recommended as a treatment for kidney cancer, especially in cases where the cancer is localized to the kidney and has not spread to other organs.

  2. Kidney stones: Nephrectomy may be recommended in cases where kidney stones are too large to pass on their own or are causing severe pain and complications.

  3. Kidney trauma: In cases of severe kidney trauma, nephrectomy may be necessary to remove the damaged kidney and prevent further complications.

  4. Polycystic kidney disease: Nephrectomy may be recommended in cases of polycystic kidney disease where the kidneys are severely enlarged and causing pain or complications.

  5. Kidney donation: In cases where an individual is donating a kidney for transplant, nephrectomy is performed to remove one of the healthy kidneys for transplantation.

Overall, nephrectomy is a common procedure for a variety of kidney conditions and is typically recommended when other treatments have been ineffective or when the condition poses a significant risk to the patient’s health.

Timeline

Before nephrectomy:

  • Patient is diagnosed with kidney cancer through imaging tests, biopsy, or other diagnostic tests
  • Patient undergoes preoperative testing, such as blood tests, imaging scans, and possibly a cardiac evaluation
  • Patient meets with a urologist and an anesthesiologist to discuss the surgery and anesthesia options
  • Patient may undergo prehabilitation, such as physical therapy or smoking cessation, to optimize their health before surgery

After nephrectomy:

  • Patient undergoes the nephrectomy surgery, which can be either open, laparoscopic, or robotic-assisted
  • Patient is closely monitored in the postoperative period for any complications, such as bleeding, infection, or kidney function issues
  • Patient may need pain management, physical therapy, and dietary modifications after surgery
  • Patient follows up with the urologist for postoperative care and surveillance for any recurrence of cancer

Overall, the timeline for a patient before and after nephrectomy involves a series of diagnostic tests, consultations with healthcare providers, surgery, and postoperative care to ensure the best possible outcome for the patient.

What to Ask Your Doctor

  1. How many nephrectomies does the hospital perform each year?
  2. What is the hospital’s complication rate for nephrectomies?
  3. How long is the typical hospital stay for patients undergoing a nephrectomy at this hospital?
  4. What is the hospital’s rate of leaving cancer at the edge of the surgery site after a nephrectomy?
  5. How often do patients undergoing a nephrectomy at this hospital require a blood transfusion?
  6. How does the hospital measure the quality of nephrectomy surgeries?
  7. Are there any specific criteria or guidelines the hospital follows to ensure high-quality nephrectomy surgeries?
  8. Are there any specific factors that may increase the risk of complications or affect the outcomes of a nephrectomy at this hospital?
  9. Are there any specific post-operative care instructions or follow-up appointments that should be followed after a nephrectomy at this hospital?
  10. Are there any other hospitals or healthcare facilities in the area that specialize in nephrectomy surgeries and may have better outcomes for patients?

Reference

Authors: Marconi L, Kuusk T, Hora M, Klatte T, Dabestani S, Capitanio U, Abu-Ghanem Y, Campi R, Fernández-Pello S, Albiges L, Bedke J, Powles T, Volpe A, Ljungberg B, Bex A. Journal: Eur Urol Oncol. 2025 Jun;8(3):616-622. doi: 10.1016/j.euo.2025.01.013. Epub 2025 Apr 10. PMID: 40210551