Surgery for renal cell carcinoma in two European urologic clinics: to compare or compete?

Objectives: To evaluate and compare the incidence, TNM staging and the current strategy for the surgical treatment of renal cell carcinoma (RCC) in two European urologic institutions, situated in Varna, Bulgaria and in Bari, Italy. Both clinics have sound experience of RCC surgery, and modern laparoscopic equipment. A retrospective chart review of all patients with RCC diagnosed and treated in the last year was conducted at the two sites. Materials and methods: In total, 88 patients (66 males and 22 females, mean age 58 years, range 24-81 years) were enrolled in the study. Comparisons were made between some clinical and pathologic parameters with an established prognostic and therapeutic impact. The type of surgery performed at both sites was analyzed as well. All these comparative studies were performed in relation to the 2008 EAU guidelines on the current management of RCC. Commercially available statistical software was used for the purpose. Results: The results showed no difference between the two sites regarding the RCC incidence and the patients' age and gender. Significant differences (p value < 0.0001) emerged in terms of: the median size of the tumors at surgery (8.5 cm in Varna, SD ± 4.04 vs. 4.4 cm in Bari, SD ± 2.02); T-stage of the tumor (Varna T1-33%, T2-30%, T3-22%, T4-15% vs. Bari T1-64%, T2-12%, T3-24%, T4-0%); N-positive disease (24% vs. 2%); distant metastases (20% vs. 2%) and presence of necrosis in the renal masses (37% vs. 19%). Thus, 85% of Varna patients underwent open radical nephrectomy, 11% nephron-sparing surgery and 4% explorative laparotomy, due to inoperability of the renal mass. Only 29% of Bari patients were treated by open radical nephrectomy, 12% underwent laparoscopic nephrectomy, 57% open partial nephrectomy and 2% laparoscopic partial tumor resection. Conclusions: These numbers demonstrate more advantageous tumour features at the Italian clinic in terms of organ-sparing surgical options (open and laparoscopic), whereas in the Bulgarian clinic the tumour features pose certain limitations to the application of modern surgical techniques. This difference is due to early diagnosis of RCC in Italy, allowing treatment of smaller volume tumors.