Robot linked with improved Kidney Ca Care

Posted: January 5, 2015

Kidney cancer patients were more likely to undergo partial nephrectomy when treated in hospitals that were early adopters of robotic surgery, according to a recent report that one leading expert calls “some of the best evidence to date of a favorable impact of surgical robots in urologic care.”

For the study, which was published in Medical Care (2015; 53:71-78), the authors analyzed retrospective data on all nephrectomies from all payers from seven states (Arizona, Florida, Maryland, North Carolina, New York, New Jersey, and Washington) to extract data on 21,569 procedures. They then sorted these procedures by hospital and associated their frequency with the timing of each hospital’s acquisition of surgical robotics.

The authors reported that by 2008, hospitals that had adopted robotic surgery at the start of the current century (between 2001 and 2004) performed partial nephrectomies in 38% of kidney cancer cases compared to 24% by late adopters (2005 to 2008). Hospitals that had not adopted robotics by 2008 performed partial nephrectomies in 20% of cases.

“Our study is the first to show, at the hospital level, that more institutional experience with robotic surgery is likely to have resulted in this increase in partial nephrectomy,” said lead author Ganesh Sivarajan, MD, of New York University Langone Medical Center, New York, in a press release from the center.

“Robotic surgery was not originally designed for treatment of kidney tumors, but what we see here is a case of reinvention, or adaptation,” said senior author Danil V. Makarov, MD, MHS, of NYU Langone. “In this case, the reinvention has served to provide patients increased access to an underutilized, guideline-supported procedure.”

Urology Times Editorial Council member J. Stuart Wolf, Jr., MD, applauded the authors’ efforts.

“This is an important article, one that builds on a hypothesis that was first introduced in 2013 by Patel and associates from Johns Hopkins, using data only from Maryland (J Urol 2013; 189:1229-35). In this new study, the authors used a novel combination of data from three sources to show that acquiring a surgical robot was associated with an increasing performance of partial nephrectomy,” said Dr. Wolf, who was not involved with the study.

“There are always limitations to retrospective database-derived studies, but this work represents some of the best evidence to date of a favorable impact of surgical robots in urologic care.”