Current state of renal tumor surgery among pediatric surgeons and pediatric urologists: A survey of American Pediatric Surgical Association (APSA) and Society for Pediatric Urology (SPU) members

Summary Introduction Anecdotally, renal tumor (RT) surgery makes up a limited portion of the practice for most pediatric urologists and pediatric surgeons. Data are lacking on the current perceptions of RT surgery, both volume of surgery and issues related to surgical practice, among pediatric surgeons (PS) and pediatric urologists (PU). Objectives To describe practice patterns of pediatric renal tumor (RT) surgery and identify factors related to higher reported volumes of RT surgery. Study design The survey was developed and pilot-tested by the Children’s Oncology Group (COG) RT surgery committee. The survey was distributed to APSA and SPU members. Logistic regression was performed to correlate surgeon-reported factors with higher reported volumes of RT surgery. Results The survey was sent to 1,282 APSA and 426 SPU members, 367 (21.5%) surveys were completed from eligible responders, 244 (65.2%) and 123 (32.9%) from APSA and SPU invitations, respectively. Overall, 33.9% reported being part of a practice group in which RT surgical care is sub-specialized. A majority (50.7%) of respondents reported personally performing one to two RT surgeries annually, and 16.7% reported performing none. Multivariate logistic regression identified the following significant factors associated with increased individual RT surgical volume: group sub-specialization, COG/SIOP membership, regular tumor board attendance, and annual institutional volume >10 RT surgeries (Table). Accurate responses on the need for lymph node (LN) sampling in RT surgery were reported by 89.9%. Overall, 15.8% and 24.5% of respondents failed to correctly correlate local stage III disease in Wilms tumor (WT) with open or percutaneous biopsy, respectively (p Discussion While we found that reported RT surgery volume is low among both pediatric urologists and surgeons, we did identify surgeon-specific factors which correlated with higher RT surgical volume. Interested pediatric urologists and surgeons may use these data to tailor their practice if their goal is to increase RT surgery volume. Additionally, based on less than ideal rates of correct responses to nuance in the staging and treatment of WT, there are clear opportunities to increase education in this content area. However, the study is limited by use of a non-validated survey instrument and the relatively low response rates. Conclusion Reported individual RT surgery volume is low. Factors associated with increased volume include sub-specialty practice, tumor board involvement, and higher institutional volume. Responses on LN sampling and biopsy in WT demonstrate opportunities for educational initiatives. Table. Multivariate logistic regression analysis of factors associated with higher reported renal tumor surgery volume (>2 per year). Univariate Multivariate OR 95% CI p OR 95% CI p Lower limit Upper limit Lower limit Upper limit Practice specialty Pediatric urology 1 (Reference) 1 (Reference) Pediatric surgery 2.567 1.532 4.301 1.497 0.598 3.748 0.389 Are you one of the sub-specialty providers Yes 7.624 4.091 14.206 8.293 3.465 19.848 No 1 (Reference) 1 (Reference) Personally a COG or SIOP member Yes 5.076 3.164 8.143 2.630 1.348 5.133 0.0015 No 1 (Reference) 1 (Reference) Personal tumor board attendance I never go 1 (Reference) 1 (Reference) 4.4 1.579 12.257 0.005 6.364 1.283 31.572 0.024 25–50% of the time 7.68 2.58 22.86 6.835 1.294 36.103 0.024 50–75% of the time 8.4 2.739 25.764 15.145 2.752 83.329 0.002 >75% of the time 19.096 7.139 51.08 19.930 4.066 97.698 Average institutional renal tumor volume 0–10 cases per year 1 (Reference) 1 (Reference) >10 cases per year 3.243 1.996 5.271 3.829 1.929 7.599 Correct answer on impact of open biopsy on staging Yes 2.152 1.056 4.384 0.035 1.132 0.347 3.693 0.838 No 1 (Reference) 1 (Reference) Correct answer on impact of percutaneous biopsy on staging Yes 2.562 1.397 4.699 0.02 1.131 0.422 3.030 0.807 No 1 (Reference) 1 (Reference) Bold indicates factors with p