Comparison of Cancer Specific Outcomes following Minimally Invasive and Open Surgical Resection of Early Stage Kidney Cancer from a National Cancer Registry

Abstract

Purpose: With anecdotal observations of atypical recurrences following minimally-invasive surgery (MIS) and alongside new concerns following cervical cancer surgery, there is a need to evaluate cancer-specific outcomes for MIS kidney cancer surgery using national data. We sought to evaluate cancer-specific outcomes following MIS versus open surgery for early-stage kidney cancer. Materials and Methods: We performed a retrospective population-based cohort study using data from the Surveillance, Epidemiology and End Results (SEER) program linked with Medicare claims that included beneficiaries, at least 66 years old, diagnosed between 2004 and 2013 with early-stage, non-urothelial kidney cancer who underwent surgical resection within a year of diagnosis. We compared overall survival, disease-specific survival, rate of second kidney cancer surgery, and rate of post-operative systemic cancer therapy based on whether surgery was MIS or an open resection. Multivariable regression was used to account for confounders. Results: 5,150 patients were included and 3,062 (59.5%) underwent MIS. On multivariable analysis, MIS was not associated with differences in overall survival (HR 0.94, 95% CI 0.84-1.06) or disease-specific survival (HR 0.96, 95% CI 0.83-1.11). MIS recipients were more likely to receive systemic cancer therapy (HR 1.31, 95% CI 1.09-1.59). No difference in the rate of second surgery associated with surgical approach was observed. Conclusions: Use of MIS for early-stage kidney cancer was not associated with differences in overall or disease-specific survival, or the rate of second kidney cancer surgery. MIS recipients received more post-operative systemic therapy. This could represent a disparate cancer-specific outcome associated with MIS.