Kidney cancer

  • Quality standard
  • QS215
  • Published: 
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Quality statement 4: Surgery with curative intent

Quality statement

Adults with high-risk localised or locally advanced renal cell carcinoma (RCC), for whom surgery is suitable, have surgery with curative intent within 31 days of the decision to treat.

Rationale

Surgery with curative intent for adults with high-risk localised or locally advanced RCC can improve survival and prevent metastatic disease. If it is suitable for the person, surgery with curative intent should be done as quickly as possible after deciding to treat. Surgery options are discussed at multidisciplinary team meetings, with adults with RCC involved in deciding which option best suits them.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of adults with high-risk localised or locally advanced RCC who have surgery with curative intent within 31 days of the decision to treat.

Numerator – the number in the denominator who have surgery within 31 days of the decision to treat.

Denominator – the number of adults with high-risk localised or locally advanced RCC who have surgery with curative intent.

Data source: The National Kidney Cancer Audit - National Cancer Audit Collaborating Centre's State of the Nation Report performance indicator dashboard presents data on surgery within 31 days of the decision to treat.

Outcome

a) One-year survival rate for adults with high-risk localised or locally advanced RCC.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. Cancer survival in England - NHS England (adult cancer survival tables for people aged 15 to 99) includes data on 1-year survival for all people with kidney cancer.

b) Five-year survival rate for adults with high-risk localised or locally advanced RCC.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records. Cancer survival in England - NHS England (adult cancer survival tables for people aged 15 to 99) includes data on 5-year survival for all people with kidney cancer.

What the quality statement means for different audiences

Service providers (such as secondary and tertiary care services) ensure that all surgery options are available for adults with high-risk localised or locally advanced RCC. They also ensure that staff are trained to discuss the risks and benefits of options and to support shared decision making.

Healthcare professionals (consultants, and clinical nurse specialists with training and experience in kidney cancer) discuss the risks and benefits of surgery options with adults with high-risk localised or locally advanced RCC, for whom surgery is suitable, and support them to make treatment decisions.

Commissioners ensure that services that provide all surgical options are available for adults with high-risk localised RCC or locally advanced RCC.

Adults with high-risk localised or locally advanced RCC, are offered surgery that may cure their cancer if it is suitable for them. They discuss options for surgery with a healthcare professional who explains the risks and benefits of each.

Source guidance

Definitions of terms used in this quality statement

High-risk localised or locally advanced RCC

Based on the Tumour Node Metastasis (TNM) staging system, this includes RCC with no distant metastases (M0) meeting any of the following criteria:

  • T3 or higher

  • stage 3 (locally advanced cancer)

  • tumour size 10 cm or larger

  • N1

that either remains confined to the kidney and surrounding structures or has grown into the surrounding tissue or blood vessels. It may have spread to nearby lymph nodes but has not spread to distant parts of the body and is operable. [NICE's guideline on kidney cancer, terms used in this guideline; the National Kidney Cancer Audit - National Cancer Audit Collaborating Centre's indicator on the management of high-risk renal masses (NKCA metrics 2024 - KC0004)].

For whom surgery is suitable

The suitability of surgery will depend on:

  • comorbidities, fitness or performance status

  • personal choice

  • tumour-related issues.

Adults having neoadjuvant systemic anticancer therapy should be excluded from denominators in the process measure because the 31‑day timeframe cannot be met. [NICE's guideline on kidney cancer, terms used in this guideline, rationale and impact sections for recommendations on surgery, thermal ablation, active surveillance or stereotactic ablative radiotherapy (SABR), and for recommendations on surgery for suspected or confirmed locally advanced RCC, and expert opinion]

Surgery with curative intent

Surgery options include partial or total nephrectomy with robot-assisted, minimally invasive or open approaches. The approach to treatment will depend on the clinical stage of the tumour, comorbidities and personal choice. [NICE's guideline on kidney cancer, recommendations 1.5.4 and 1.7.2]

Equality and diversity considerations

Healthcare professionals must ensure that adults with RCC are not excluded from surgery with curative intent because of their age, disability or where they live. They should support adults to consider all the options carefully, even if they will need to travel to another hospital, before deciding which option suits them best. Adults should be made aware that they may be eligible for the NHS healthcare travel costs scheme.