Changing trends in the presentation and management of renal tumors

Introduction: We have analyzed the changing trends in surgical treatment of renal tumors over the last decade with regard to age incidence, presentation, incidental detection, and histopathology.
Methods: Records of renal tumors were analyzed to see change in surgical pattern in last decade. The data was split into 2 parts (cohort) based on five year time period. Cohort 1 from 2006-2010 and cohort 2 from 2011 to 2015. For cohort 2 a comparative study was also performed with regard to age incidence, presentation, incidentallomas, histopathology, and management with statistical analysis.
Results: Total 445 nephrectomies were done. In cohort1 175 (87%) were radical and 22(13%) were partial nephrectomty. In Cohort2 178(71.7%) underwent radical and 70(28.2%) partial nephrectomy. In cohort1 robotic approach was used in 21(12%) in comparison to 7(3.9%) radical nephrectomy in cohort2. 5(22%) partial nephrectomies were done by robotic approach in cohort1 which increased to 24(34.3%) in cohort2. Common histopathology was clear cell carcinoma and papillary RCC. 8 % were benign, oncocytoma being the commonest. There was no difference in gender ratio, histopathology and age with regard to type of surgery. 30% of tumors were incidentally detected which in partial nephrectomy group were 60% in comparison to 20% in radical nephrectomy group (p=0.001). Tumors resected by partial nephrectomy were smaller (Mean size, 4.4cm) than those resected by radical nephrectomy (Mean size, 8.3cm).
Conclusion: Due to detection of early stage incidental tumors and gain in experience in minimally invasive surgery there is increasing trend towards NSS for renal tumors.