Quality metrics for Renal Cell Carcinoma (RCC) surgical care: Insights from a large contemporary multi-institutional registry

Introduction & Objectives: Despite efforts to define standardized metrics assessing the quality of renal cell carcinoma (RCC) surgical care, there is a paucity of validated quality indicators (QI) to evaluate RCC surgery. Moreover, there is a lack of evidence on the impact of QIs on real-world clinical practice (i.e. centralization of care, patterns for referral, and definition of Centres of excellence for RCC care). In this study we leveraged a large contemporary surgical registry to explore the proportion of patients meeting a predefined set of QIs for RCC surgery. Materials & Methods: After Institutional Review Board approval, we retrospectively queried a multi-institutional database promoted by the EAU Young Academic Urologists (YAU) Renal Cancer working group to select patients with a single cT1-2N0M0 renal mass treated with either partial (PN) or radical (RN) nephrectomy at referral 13 centers worldwide from 2015 to 2023. A set of “process” QIs was developed according to a structured pathway including the following steps: a) extensive review of the available literature; b) selection of validated and non-validated potential QIs; c) internal confidential survey within the YAU RCC working group (scoring each potential QI on a 1-10 Likert scale); d) definition of a core set of QIs by selecting those QIs scored > 8 by >75% of members). We then analyzed the core set of QIs, previously validated QIs (regardless of the consensus) and two novel exploratory QIs reaching the consensus. Results: Consensus was reached for one (validated) QI, namely the “proportion of patients undergoing PN for a T1a renal mass” (QI1) as well as the exploratory QIs (“proportion of patients undergoing minimally-invasive PN” [QI2] and “proportion of patients undergoing PN for a T1b renal mass” [QI3]). Conversely, there was no consensus on two previously validated QIs (“proportion of patients undergoing minimallyinvasive RN for a T1-T2 renal mass” [QI4] and the “proportion of patients with negative surgical margins after PN” [QI5]). Of 9806 patients included in the analytic cohort, QI1 was reached in 5301/5835 (91%) patients; QI2 in 7118/7661 (93%); QI3 in 1985/2995 (66%); QI4 in 1856/2145 (87%); and QI5 in 6187/6584 (94%). mass underwent PN, warranting further audit on surgical decision-making in this cohort. Further research is needed to investigate the patient-, tumour- and provider-related factors influencing treatment decisions and achievement of QIs toward value-based healthcare.