Population-level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer.
Population-level comparative effectiveness of laparoscopic versus open radical nephrectomy for patients with kidney cancer.
复制标题
腹腔镜与开腹根治性肾切除术对肾癌患者的人群水平比较疗效。
作者：
Tan,Hung-Jui;WolfJr,JStuart;Ye,Zaojun;Wei,JohnT;Miller,DavidC
研究基础由于在广泛采用腹腔镜根治性肾切除术（LRN）后，支持其比较有效性的基于人群的证据有限，我们比较了LRN或开放根治性肾切除术（ORN）治疗肾癌患者的医院结局趋势。方法使用相关SEER-Medicare数据，作者确定了2000年至2005年接受LRN或ORN治疗的肾癌患者。作者测量了4个主要结局：重症监护室（ICU）入院、住院时间延长、30天再入院和住院死亡率。然后，作者估计手术方法和每个结果之间的关联，调整患者的人口统计学，肿瘤特征和手术年份。作者确定了2108（26%）和5895（74%）例患者分别接受LRN和ORN治疗。接受LRN治疗的患者更可能是白色、女性、较高的社会经济地位、肿瘤大小≤4 cm（均P <0.05）。LRN患者调整后入住ICU和延长住院时间的概率分别降低41%和46%（P<0.001）。尽管两组患者的住院死亡率均不常见，但腹腔镜治疗患者的调整后住院死亡率概率高出51%（2.3%vs 1.5%，P = 0.04）。结论在人群水平上，LRN治疗患者入住ICU的可能性较低，住院时间较长，支持腹腔镜的康复益处。然而，接受LRN治疗的患者的住院死亡率较高。后一项发现表明，该技术可能会产生意想不到的后果，并强调在广泛采用新手术技术期间和之后需要进行长期监测。Cancer 2011;.© 2011美国癌症协会。
BACKGROUNDBecause there is limited population‐based evidence supporting the comparative effectiveness of laparoscopic radical nephrectomy (LRN) after its widespread adoption, we compared trends in hospital‐based outcomes among patients with kidney cancer treated with LRN or open radical nephrectomy (ORN).METHODSUsing linked SEER‐Medicare data, the authors identified patients with kidney cancer who were treated with LRN or ORN from 2000 through 2005. The authors measured 4 primary outcomes: intensive care unit (ICU) admission, prolonged length of stay, 30‐day hospital readmission, and in‐hospital mortality. The authors then estimated the association between surgical approach and each outcome, adjusting for patient demographics, tumor characteristics, and year of surgery.RESULTSThe authors identified 2108 (26%) and 5895 (74%) patients treated with LRN and ORN, respectively. Patients treated with LRN were more likely to be white, female, of higher socioeconomic position, and to have tumor sizes of ≤4 cm (allP< .05). The adjusted probability of ICU admission and prolonged length of stay was 41% and 46% lower, respectively, for patients undergoing LRN (P< .001). Although uncommon for both groups, the adjusted probability of in‐hospital mortality was 51% higher (2.3% vs 1.5%,P= .04) for patients treated with a laparoscopic approach.CONCLUSIONSAt a population level, patients treated with LRN have a lower likelihood of ICU admission and prolonged length of stay, supporting the convalescence benefits of laparoscopy. In‐hospital mortality, however, was higher among patients treated with LRN. The latter finding suggests a potentially unanticipated consequence of this technique and highlights the need for long‐term monitoring during and after the widespread adoption of new surgical technologies. Cancer 2011;. © 2011 American Cancer Society.