Renal ca surgery often determined by doctors’ practice style

A new study shows that the type of surgery a patient with renal cancer receives depends more on the surgeon’s preference than on the patient’s tumor size, demographic characteristics, or general medical health (Miller et al: Cancer, published online March 10, 2008, DOI: 10.1002/cncr.23372).

The findings suggest that patients with renal cancer often may not be receiving the most appropriate surgical care, said David Miller, MD, and colleagues from UCLA.

To investigate the potential barriers to adoption of partial nephrectomy and renal laparoscopy, Dr. Miller and his colleagues reviewed SEER and Medicare data to identify Medicare beneficiaries with localized renal cancer diagnosed between 1997 and 2002, determine the type of surgery received by each patient, and identify the primary surgeon for each case.

They found 611 patients who underwent partial nephrectomy and 4,872 who had radical nephrectomy, 515 of which were performed laparoscopically.

After taking into consideration factors including patient demographics, comorbidity, tumor size, and volume of surgeries done by each surgeon, the investigators found considerable variation among surgeons in the type of surgery they performed—an 18.1% variance for partial nephrectomy and a 37.4% variance for laparoscopy.

Factors based on surgeons’ practice style contributed more to these variances than did patient characteristics.

The authors concluded that “for many older patients with kidney cancer, the surgery provided may depend more on their surgeon’s practice style than on the characteristics of the patient and his or her disease.”