| アブストラクト | BACKGROUND: Despite increasing interest in minimally invasive surgery, prevalence data are completely absent. Our objective was to analyze clinico-epidemiological variations of surgery for renal malignancy in Japan with emphasis on annual trends and regional gaps, and to analyze factors affecting choice of open versus minimally invasive surgery. METHODS: We identified patients who underwent open (n = 8646), laparoscopic (n = 5932), or minimum incision endoscopic surgery (MIES) (n = 381) nephrectomy for renal malignancy, using the Japanese Diagnosis Procedure Combination database, 2007-2010. Clinical and regional variations in these three approaches were determined, and the annual per-population incidence of nephrectomy was estimated. Multivariate logistic regression was used to analyze factors affecting choice of minimally invasive surgery (laparoscopy or MIES). RESULTS: The proportion of open nephrectomy decreased from 65.3 % in 2007 to 51.6 % in 2010. Laparoscopic nephrectomy accounted for 51.0 % of procedures for T1 tumors. The estimated incidence of nephrectomy in males and females was 14.3 and 6.1 per 100,000 person-years, respectively. Multivariate analysis showed that minimally invasive nephrectomy was more likely to be selected for patients in their 30-50s who had less comorbidity, better performance status, or lower TNM stage, in high-volume or academic hospitals, especially in western Japan. Hemodialysis use was a favorable factor. CONCLUSION: Despite differences between eastern and western Japan, minimally invasive surgery is becoming widespread throughout Japan, especially for patients with low operative risks and early-stage cancer who are hospitalized in high-volume institutes. |
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| ジャーナル名 | International journal of clinical oncology |
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| 投稿日 | 2012/11/28 |
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| 投稿者 | Sugihara, Toru; Yasunaga, Hideo; Horiguchi, Hiromasa; Tsuru, Nobuo; Fujimura, Tetsuya; Nishimatsu, Hiroaki; Kume, Haruki; Ohe, Kazuhiko; Matsuda, Shinya; Fushimi, Kiyohide; Homma, Yukio |
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| 組織名 | Department of Urology, Shintoshi Hospital, Iwata, Japan, ezy04707@nifty.com. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/23179640/ |
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