The influence of surgical volume on partial nephrectomy (PN) outcomes is a subject of debate. The European Association of Urology (EAU) renal cell carcinoma (RCC) guideline panel performed a protocol-driven systematic review of the association between hospital volume (HV) and oncological, functional, and complication outcomes following PN for RCC. The intervention was PN performed in a higher-volume hospital (defined according to the number of procedures per unit time) and the comparator was PN performed in a lower-volume hospital. Ten studies involving a total of 106 569 patients were included in the review. Higher HV was associated with lower complication rates, shorter length of stay, lower positive surgical margin rates, and lower transfusion rates. For six studies, multivariable analyses showed that low HV was an independent risk factor for inpatient complications, PSM presence, longer LOS, and failure to achieve a trifecta of no complications, warm ischemia time <25 min, and negative surgical margins. Most studies were judged to have high risk of bias. The available evidence suggests a potential association between higher HV and better PN outcomes in RCC. The EAU RCC guidelines panel encourages the development and rigorous evaluation of indicators of surgery quality in RCC to better inform the designation of high-quality centers within models of centralized care.
European urology oncology. 2025 Apr 09 [Epub ahead of print]
Lorenzo Marconi, Teele Kuusk, Milan Hora, Tobias Klatte, Saaed Dabestani, Umberto Capitanio, Yasmin Abu-Ghanem, Riccardo Campi, Sergio Fernández-Pello, Laurence Albiges, Jens Bedke, Thomas Powles, Alessandro Volpe, Börje Ljungberg, Axel Bex
Department of Urology and Renal Transplantation, Unidade Local de Saúde de Coimbra, Coimbra, Portugal. Electronic address: ., Department of Urology, Darent Valley Hospital, Dartford and Gravesham NHS Trust, Dartford, UK., Department of Urology, University Hospital Pilsen and Faculty of Medicine in Pilsen, Charles University, Czechia., Department of Urology, Helios Hospital Bad Saarow, Bad Saarow, Germany., Department of Urology, Kristianstad Central Hospital, Kristianstad, Sweden; Department of Translational Medicine, Division of Urological Cancers, Lund University, Lund, Sweden., Department of Urology, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy., Guy's and St. Thomas' NHS Foundation Trust, London, UK., Unit of Urologic Robotic Surgery and Renal Transplantation, Careggi University Hospital, Florence, Italy., Department of Urology, Cabueñes University Hospital, Gijón, Spain., Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France., Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Department of Urology, University Hospital Tübingen, Tübingen, Germany; German Cancer Consortium and German Cancer Research Center, Heidelberg, Germany., Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK., Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy., Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden., Royal Free London NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.