Utilization of radical nephrectomy for patients with clinical stage T1 renal masses: Evaluation of opportunities for quality improvement

Document Type

Article

Publication Date

2-1-2026

Publication Title

Urologic oncology

Keywords

Humans, Nephrectomy, Kidney Neoplasms, Male, Female, Quality Improvement, Middle Aged, Aged, Neoplasm Staging, Patient Selection, Registries

Abstract

PURPOSE: To determine opportunities for quality improvement (QI) in patient selection for radical nephrectomy (RN) for cT1 renal masses (cT1RM).

MATERIALS AND METHODS: The MUSIC (Michigan Urological Surgery Improvement Collaborative) registry was queried for RN performed for any localized RM ≤4 cm (cT1aRM) or low/intermediate/unrecorded complexity RM 4 to 7 cm (cT1bRM). Eight experienced kidney surgeons reviewed characteristics (age, GFR, medical comorbidities, RENAL score, tumor size, and more) of de-identified cases. Each reviewer provided a score regarding opportunity for QI (none = 0, minor = 1, moderate = 2, major = 3) that were averaged.

RESULTS: 171 cases met inclusion criteria, including 77 cT1aRM and 94 cT1bRM. Urologists agreed on a score of no (0) or minor (0.1-1) QI opportunities in 40% (n = 68) and 41% (n = 70) of cases, respectively. These patients had (1) ≥1 of the following features: on dialysis; elderly, comorbid, or anticoagulated with normal GFR; (2) cT1bRM and RENAL ≥8; (3) not amenable to partial nephrectomy (PN) or biopsy based on location or cystic nature; or (4) attempted PN. Thirty-three cases had moderate (14%) or major (4%) QI opportunities including 30% of cT1aRM and 11% of reviewed cT1bRM. Case characteristics included: smaller and/or lower complexity tumors, younger age, baseline CKD, and/or would have benefitted from active surveillance and/or pretreatment biopsy.

CONCLUSIONS: Surgeon-reviewers identified moderate/major opportunities for QI in 33 patients that underwent RN who may have been spared from kidney loss. Kidney loss can be prevented by considering active surveillance, confirmatory imaging, renal mass biopsy, and/or kidney-sparing interventions in patients with T1aRM, low/intermediate complexity T1bRM, young patients, and patients with CKD.

Medical Subject Headings

Humans; Nephrectomy; Kidney Neoplasms; Male; Female; Quality Improvement; Middle Aged; Aged; Neoplasm Staging; Patient Selection; Registries

PubMed ID

41242940

Volume

44

Issue

2

First Page

19

Last Page

28

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