To determine opportunities for quality improvement (QI) in patient selection for radical nephrectomy (RN) for cT1 renal masses (cT1RM).
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.
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.
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.
Urologic oncology. 2025 Nov 15 [Epub ahead of print]
Alice Semerjian, Emily Fisher, Amit Patel, Anna Johnson, Monica Van Til, Sabrina L Noyes, Brian Seifman, William K Johnston, Jason Hafron, Thomas Maatman, Craig G Rogers, Brian R Lane
Department of Urology, Michigan Medicine, Ann Arbor, MI., Department of Urology, Wayne State University, Detroit, MI., Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI., Department of Urology, Corewell Health Hospital System, Grand Rapids, MI. Electronic address: ., Michigan Institute of Urology, Utica, MI., Michigan Institute of Urology, Utica, MI; Department of Urology, Oakland University, Rochester, MI., Department of Urology, Michigan Urological Clinic, Grand Rapids, MI., Department of Urology, Corewell Health Hospital System, Grand Rapids, MI; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, MI.