A Prospective Survey of Surgical Approaches in Clinically Localized Renal Cell Carcinoma--A Preliminary Attempt at Surgical Quality Control

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Abstract
We analyzed the inter-institutional variability of factors related to the performance and outcome of surgery for localized renal cell carcinoma (RCC). Data were prospectively collected from 41 urologists that performed 168 radical nephrectomies for RCC. The participants reported on the surgeon, the incision, the stage, the need for blood transfusion, the duration of surgery and the gastrointestinal decompression. The timing of the start of oral intake, pain control, the time of discharge from the hospital and the early complications of surgery were also investigated. One third of the urologists perform routine lymphadenectomy and one fourth adrenalectomy. The flank incision was the most popular, followed by Chevron and midline abdominal incisions. There are differences in the approach to radical nephrectomy in Europe and this has an impact on the quality of life of the patients and on health economics. There is an urgent need to assess surgical quality for localized RCC.