Urological Survey Urological Oncology : Adrenal , Renal , Ureteral and Retroperitoneal Tumors Re : Partial vs Radical Nephrectomy for T 1 Renal Tumours : An Analysis from the British Association of Urological Surgeons Nephrectomy Audit

available at http://www.ncbi.nlm.nih.gov/pubmed/25754386 Editorial Comment: At request of the National Health Service in 2012 the British Association of Urological Surgeons (BAUS) launched an audit of kidney surgery. Aimed to monitor individual surgeon performance, the audit results reflect the activity of 80% of United Kingdom urology consultants. In this article the BAUS reports patterns of treatment and perioperative complications in T1 renal tumor cases. Of 768 patients with T1 tumors registered during 2012 radical nephrectomy (RN) was performed in 61% and partial nephrectomy (PN) in 39%. As in previous population based/international registries, the data show a better clinical profile and increasing preference for PN. PN was elective in 71% of cases. Of patients with T1a tumors PN was performed in 55.6%, with almost half of procedures being performed via a minimally invasive approach. By comparison, 90% of RNs were performed using a minimally invasive approach. Operative parameters, intraoperative complications and transfusion rates did not differ between RN and PN. Rate of positive surgical margins was within the range reported in the literature. As expected, 30-day complication rates were significantly higher following PN (17.6% vs 11.3%, p <0.001), including Clavien-Dindo category 3 and greater complications. Although not new, this information frames contemporary data by opposing retrospective series with lower degrees of bias. The authors describe well the limitations of their study in terms of reflection of activity in the United Kingdom, accurate and consistent reporting, restrictions imposed by use of standardized templates and lack of mandatory reporting for some fields. They recognize that the public character of the data may have compelled optimistic reporting of complications, which raises concerns regarding clinical data provided by registries. How this information is going to be used, and by whom, is not yet known. Public access to national/ institutional registries is fair as long as the appropriate tools are used to measure performance. These tools are difficult to characterize and capture, and basing recertification, centralization and practice restrictions, among other things, on raw registry data without supporting medical evidence could be unwise and lead to erroneous decisions. M. Pilar Laguna, MD, PhD 0022-5347/16/1955-1377/0 THE JOURNAL OF UROLOGY 2016 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH, INC. http://dx.doi.org/10.1016/j.juro.2016.02.011 Vol. 195, 1377-1382, May 2016 Printed in U.S.A. www.jurology.com j 1377 1378 ADRENAL, RENAL, URETERAL AND RETROPERITONEAL TUMORS