Relationship between surgical volume and outcomes in nephron-sparing surgery.
Résumé
Provider volume has been shown to affect outcomes of various surgical procedures. Because of its technical complexity, it is likely that partial nephrectomy outcomes can be affected by hospital and/or surgeon volume. However, until recently, there were few publications on the subject. Our objective is to discuss recent findings on the impact of surgical volume on partial nephrectomy outcomes. Two studies found a link between the number of partial nephrectomy performed at an institution and postoperative outcomes. Data extrapolated from articles on learning curve of laparoscopic partial nephrectomy suggest that surgeon volume can also affect partial nephrectomy outcomes. Partial nephrectomy is underused in low-volume centers. Robotic partial nephrectomy has a shorter learning curve compared to laparoscopic partial nephrectomy and may increase the use of partial nephrectomy vs. radical nephrectomy. Results on the impact of provider volume on the surgical approach are conflicting. There are few publications suggesting an impact of hospital volume on partial nephrectomy outcomes but the importance of the surgeon volume remains unclear. Higher surgical volume is associated with increased use of partial nephrectomy.