OncologyA Contemporary Analysis of the 30-day Morbidity and Mortality Associated With Cytoreductive Nephrectomy
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
References (18)
- et al.
EAU guidelines on renal cell carcinoma: 2014 update
Eur Urol
(2015) - et al.
Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial
Lancet
(2001) - et al.
The outcome of patients treated with sunitinib prior to planned nephrectomy in metastatic clear cell renal cancer
Eur Urol
(2011) - et al.
Safety of presurgical targeted therapy in the setting of metastatic renal cell carcinoma
Eur Urol
(2011) - et al.
In-hospital mortality and failure to rescue after cytoreductive nephrectomy
Eur Urol
(2013) - et al.
Impact of cytoreductive nephrectomy on eligibility for systemic treatment and effects on survival: are surgical complications or disease related factors responsible?
Urology
(2011) - et al.
The association between small primary tumor size and prognosis in metastatic renal cell carcinoma: insights from two independent cohorts of patients who underwent cytoreductive nephrectomy
Eur Urol Oncol
(2020) - et al.
Laparoscopic versus open cytoreductive nephrectomy for metastatic renal cell carcinoma
Urology
(2004) - et al.
Cancer statistics, 2018: cancer statistics, 2018
CA Cancer J Clin
(2018)
Cited by (6)
Cytoreductive Nephrectomy Following Immune Checkpoint Inhibitor Therapy Is Safe and Facilitates Treatment-free Intervals
2023, European Urology Open ScienceThe geriatric nutritional risk index predicts complications after nephrectomy for renal cancer
2023, International Braz J UrolThe impact of hypoalbuminemia on postoperative outcomes after outpatient surgery: a national analysis of the NSQIP database
2022, Canadian Journal of AnesthesiaCytoreductive Nephrectomy in the Management of Metastatic Renal Cell Carcinoma: Is There Still a Debate?
2021, Current Urology Reports