Elsevier

Urology

Volume 147, January 2021, Pages 186-191
Urology

Oncology
A Contemporary Analysis of the 30-day Morbidity and Mortality Associated With Cytoreductive Nephrectomy

https://doi.org/10.1016/j.urology.2020.10.016Get rights and content

Abstract

Objective

To examine the rates of adverse surgical outcomes in patients undergoing cytoreductive nephrectomy (CN) compared to patients undergoing radical nephrectomy in the nonmetastatic setting using a large administrative database.

Methods

Patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) who underwent a radical nephrectomy between 2011 and 2016 were included. Patients were stratified by the preoperative variable of presence or absence of metastatic cancer. Perioperative outcomes were compared. A multivariable logistic regression analysis was performed to test the association between patients with metastatic cancer and perioperative morbidity and 30-day mortality.

Results

There were 15,869 total patients included in this analysis of whom 1322 (8%) patients had metastatic cancer. Of the entire cohort, the majority of patients were over 60 years old (58%) and 9621 (61%) were male. Seventy-three of the patients were Caucasian. Patients with metastatic cancer had more minor (P< .01) and major (P< .01) complications, a higher rate of reoperation (P< .01), and a higher rate of unplanned readmissions (P< .01). Finally, the cohort with metastatic cancer had a higher rate of postoperative 30-day mortality (P< .01) than patients without metastatic cancer.

Conclusion

Patients undergoing a CN have significantly worse perioperative outcomes than patients undergoing a radical nephrectomy without evidence of metastases. Careful surgical risk stratification and appropriate patient counseling should be undertaken when selecting candidates for CN.

Section snippets

METHODS

Data for this study were obtained from the ACS-NSQIP, which is a database that collects information from patients postsurgery from participating institutions. Postoperative complications, preoperative health data, and demographic information are collected to allow for complete analysis and outcome assessment. For this study, patients between the years 2011 and 2016 were identified by the Current Procedural Terminology (CPT) code 50220 (nephrectomy, including partial ureterectomy, any open

RESULTS

A total of 15,869 patients were included in this analysis. Of the total cohort, 61% of the patients were male, and 73% were Caucasian. Stratified by the presence of metastatic cancer, there were 1322 (8%) patients who were diagnosed with metastatic cancer while the remaining 14,547 (92%) patients were not metastatic (Table 1).

Patients with metastatic cancer were more likely to be male (67%, P < .01), older than 60 years of age (59%, P < .01), Caucasian (78%, P < .01), have hypertension (59%, P

DISCUSSION

In this study of 15,869 patients undergoing radical nephrectomy, 8% of patients (1322) had metastatic cancer at the time of radical nephrectomy. Complication rates and mortality were statistically significantly lower in the localized cancer patient population. Not surprisingly, comorbidities including diabetes, COPD, ascites, CHF, hypertension, and renal failure were all associated with an increasing risk of overall complications postoperatively. Finally, a significant portion of the cases in

CONCLUSION

The exact role of CN as part of the treatment of patients with metastatic RCC is currently under debate and studies are in process. Patients undergoing CN with metastatic RCC have significantly worse perioperative outcomes than patients with localized cancer. An increased number of patients with metastatic cancer undergoing open surgery and patients with tumor thrombus are likely significant factors contributing to this difference. These data add to the volume of literature on perioperative

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