Research Article| Volume 43, ISSUE 4, P815-822, April 2017

Mortality, morbidity and healthcare expenditures after local tumour ablation or partial nephrectomy for T1A kidney cancer

Published:September 17, 2016DOI:



      Local tumour ablation (LTA) may yield better perioperative outcomes than partial nephrectomy (PN), however the impact of each treatment on perioperative mortality and health care expenditures is unknown. The aim of the study was to compare mortality, morbidity and health care expenditures between LTA and PN.

      Patients and methods

      A population-based assessment of 2471 patients with cT1a kidney cancer treated with either LTA or PN, between 2000 and 2009, in the SEER-Medicare database was performed. After propensity score matching, 30-day mortality, overall and specific complication rates, length of stay, readmission rates and health care expenditures according to LTA or PN were estimated. Multivariable logistic and linear models addressed the effect of each specific LTA approach on overall complication rates, length of stay, readmission rates and health care expenditures.


      The 30-day mortality was <2% after either LTA or PN (OR 2.27, p = 0.2). The overall complication rate was 21% after LTA and 40% after PN (OR 0.38, p < 0.001). Blood transfusions, infection/sepsis, wound infections, respiratory complications, gastrointestinal complications, acute kidney injury, and accidental puncture or laceration/foreign body left during procedure rates resulted lower after LTA relative to PN (all p < 0.05). Similarly, length of stay and health care expenditures resulted lower after LTA relative to PN (all p < 0.05). Conversely, readmission rate was not significantly different in LTA relative to PN (p = 0.1).


      Despite similar perioperative mortality, LTA is associated with lower complications rate, shorter length of stay and lower health care expenditure relative to PN.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Surgical Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Motzer R.J.
        • Jonasch E.
        • Agarwal N.
        • et al.
        Kidney cancer, version 3.2015.
        J Natl Compr Canc Netw. 2015; : 151-159
        • Ljungberg B.
        • Bensalah K.
        • Canfield S.
        • et al.
        EAU guidelines on renal cell carcinoma: 2014 update.
        Eur Urol. 2015; 67: 913-924
        • Larcher A.
        • Fossati N.
        • Lazzeri M.
        • Buffi N.
        • Guazzoni G.
        Re: systematic review and meta-analysis of perioperative and oncologic outcomes of laparoscopic cryoablation versus laparoscopic partial nephrectomy for the treatment of small renal tumors.
        J Urol. 2014; 192: 1887-1888
        • Thompson R.H.
        • Atwell T.
        • Schmit G.
        • et al.
        Comparison of partial nephrectomy and percutaneous ablation for cT1 renal masses.
        Eur Urol. 2015; 67: 252-259
        • Chang X.
        • Zhang F.
        • Liu T.
        • et al.
        Radio frequency ablation versus partial nephrectomy for clinical T1b renal cell carcinoma: long-term clinical and oncologic outcomes.
        J Urol. 2015; 193: 430-435
        • Larcher A.
        • Fossati N.
        • Mistretta F.
        • et al.
        Long-term oncologic outcomes of laparoscopic renal cryoablation as primary treatment for small renal masses.
        Urol Oncol. 2015; 33: 22.e1-22.e9
        • Ramirez D.
        • Ma Y.-B.
        • Bedir S.
        • Antonelli J.A.
        • Cadeddu J.A.
        • Gahan J.C.
        Laparoscopic radiofrequency ablation of small renal tumors: long-term oncologic outcomes.
        J Endourol. 2014; 28: 330-334
        • Johnson S.
        • Pham K.N.
        • See W.
        • Begun F.P.
        • Langenstroer P.
        Laparoscopic cryoablation for clinical stage T1 renal masses: long-term oncologic outcomes at the Medical College of Wisconsin.
        Urology. 2014; 84: 613-618
        • Warren J.L.
        • Klabunde C.N.
        • Schrag D.
        • Bach P.B.
        • Riley G.F.
        Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population.
        Med Care. 2002; 40 (IV–3–18)
        • Miller D.C.
        • Saigal C.S.
        • Warren J.L.
        • et al.
        External validation of a claims-based algorithm for classifying kidney-cancer surgeries.
        BMC Health Serv Res. 2009; 9: 92
        • Larcher A.
        • Meskawi M.
        • Valdivieso R.
        • et al.
        Comparison of renal function detriments after local tumor ablation or partial nephrectomy for renal cell carcinoma.
        World J Urol. 2015; 34: 383-389
        • Ghani K.R.
        • Sukumar S.
        • Sammon J.D.
        • Rogers C.G.
        • Trinh Q.-D.
        • Menon M.
        Practice patterns and outcomes of open and minimally invasive partial nephrectomy since the introduction of robotic partial nephrectomy: results from the nationwide inpatient sample.
        J Urol. 2014; 191: 907-913
        • Sun M.
        • Abdollah F.
        • Liberman D.
        • et al.
        Racial disparities and socioeconomic status in men diagnosed with testicular germ cell tumors.
        Cancer. 2011; 117: 4277-4285
        • Klabunde C.N.
        • Potosky A.L.
        • Legler J.M.
        • Warren J.L.
        Development of a comorbidity index using physician claims data.
        J Clin Epidemiol. 2000; 53: 1258-1267
        • Sun M.
        • Bianchi M.
        • Hansen J.
        • et al.
        Chronic kidney disease after nephrectomy in patients with small renal masses: a retrospective observational analysis.
        Eur Urol. 2012; 62: 696-703
        • Shuch B.
        • Hofmann J.N.
        • Merino M.J.
        • et al.
        Pathologic validation of renal cell carcinoma histology in the surveillance, epidemiology, and end results program.
        Urol Oncol. 2014; 32: 23.e9-23.e13
        • Hu J.C.
        • Gandaglia G.
        • Karakiewicz P.I.
        • et al.
        Comparative Effectiveness of robot-assisted versus open radical prostatectomy cancer control.
        Eur Urol. 2014; 66: 666-672
        • Norton E.C.
        Long-term survival following partial vs radical nephrectomy among older patients with early-stage kidney cancer.
        JAMA. 2012; 307: 1629
        • McDonald K.M.
        • Romano P.S.
        • Geppert J.
        • et al.
        Measures of patient safety based on hospital administrative data – the patient safety indicators.
        • Williams S.B.
        • Amarasekera C.A.
        • Gu X.
        • et al.
        Influence of surgeon and hospital volume on radical prostatectomy costs.
        J Urol. 2012; 188: 2198-2204
      1. CPI inflation Calculator, United States Dept. Of Labor. 2014.

        • Vickers A.J.
        • Sjoberg D.D.
        Guidelines for reporting of statistics in European urology.
        Eur Urol. 2015; 67: 181-187
        • D'Agostino Sr., R.B.
        Adjustment methods: propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Tutorials in biostatistics.
        John Wiley & Sons, Ltd, Chichester, UK2005: 67-83
        • Larcher A.
        • Trudeau V.
        • Sun M.
        • et al.
        Population-based assessment of cancer-specific mortality after local tumour ablation or observation for kidney cancer: a competing risks analysis.
        BJU Int. 2015; (n/a–n/a)
        • Ho D.E.
        • Imai K.
        • King G.
        • Stuart E.A.
        MatchIt: nonparametric preprocessing for parametric causal inference.
        J Stat Soft. 2011; 42
        • Larcher A.
        • Fossati N.
        • Tian Z.
        • et al.
        Prediction of complications following partial nephrectomy: Implications for ablative techniques candidates.
        Eur Urol. 2015;
        • Klatte T.
        • Grubmüller B.
        • Waldert M.
        • Weibl P.
        • Remzi M.
        Laparoscopic cryoablation versus partial nephrectomy for the treatment of small renal masses: Systematic review and cumulative analysis of observational studies.
        Eur Urol. 2011; 60: 435-443
        • Klatte T.
        • Shariat S.F.
        • Remzi M.
        Systematic review and meta-analysis of perioperative and oncologic outcomes of laparoscopic cryoablation versus laparoscopic partial nephrectomy for the treatment of small renal tumors.
        J Urol. 2014; 191: 1209-1217
        • Trudeau V.
        • Becker A.
        • Roghmann F.
        • et al.
        Local tumor destruction in renal cell carcinoma—an inpatient population-based study.
        Urol Oncol. 2014; 32: 54.e1-54.e7
        • Clavien P.A.
        • Barkun J.
        • de Oliveira M.L.
        • et al.
        The Clavien-Dindo classification of surgical complications.
        Ann Surg. 2009; 250: 187-196
        • Ficarra V.
        • Novara G.
        • Secco S.
        • et al.
        Preoperative Aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery.
        Eur Urol. 2009; 56: 786-793
        • Kutikov A.
        • Uzzo R.G.
        The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth.
        J Urol. 2009; 182: 844-853
        • Schmit G.D.
        • Thompson R.H.
        • Kurup A.N.
        • et al.
        Usefulness of R.E.N.A.L. nephrometry scoring system for predicting outcomes and complications of percutaneous ablation of 751 renal tumors.
        J Urol. 2013; 189: 30-35