Nephrectomy and inferior vena cava thrombectomy for renal cell carcinoma among patients with impaired renal function: defining predictors of outcomes.
BACKGROUND
Management of renal cell carcinoma (RCC) with inferior vena cava thrombus (IVCT) is associated with high morbidity. Chronic kidney disease (CKD) is a known risk factor for perioperative complications in many surgical procedures. The objective of this study was to review the association between preoperative CKD (eGFR < 60 mL/min) and post-operative outcomes in patients with RCC and IVCT undergoing radical nephrectomy (RN) and tumour thrombectomy (TT).


METHODS
A retrospective review of patients with RCC and IVCT treated with RN and TT was carried out. Complications were recorded according to the Clavien-Dindo classification. Multivariable models were fitted using logistic regression analyses for high-grade complications and salvage therapies and linear-regression for intraoperative blood loss (IBL).


RESULTS
One hundred and one patients with RCC and IVCT, treated with RN and TT, were identified. Forty per cent of patients had preoperative CKD. Median IBL was higher in CKD arm (2.5 versus 1.6 L, P = 0.04). In a multivariate linear regression analysis, CKD (beta 1.34, P = 0.01) remained an independent predictor of IBL. High-grade complications were more frequent in the CKD group (34% versus 16%, P = 0.09) and in logistic regression analysis, CKD was an independent predictor of high-grade complications (OR 3.33, 95% CI 1.01-10.9). Furthermore, CKD patients were less likely to be considered for salvage therapies (62% versus 38%, P = 0.02).


CONCLUSIONS
In patients treated with RN and TT, CKD is an independent predictor of perioperative morbidity. This clinical variable should be considered when selecting patients and subsequent efforts should be made to optimize other competing risk factors in order to reduce the incidence of perioperative adverse events in this patient population.
['Zargar-Shoshtari|Kamran|K|', 'Ashouri|Kenan|K|', 'Sharma|Pranav|P|', 'Baumgarten|Adam|A|', 'Sexton|Wade J|WJ|', 'Pow-Sang|Julio|J|', 'Spiess|Philippe E|PE|']
D000368:Aged D016063:Blood Loss, Surgical D002292:Carcinoma, Renal Cell D005260:Female D006801:Humans D007680:Kidney Neoplasms D008297:Male D008875:Middle Aged D009392:Nephrectomy D051437:Renal Insufficiency D012189:Retrospective Studies D012307:Risk Factors D016879:Salvage Therapy D016019:Survival Analysis D017131:Thrombectomy D016896:Treatment Outcome D014682:Vena Cava, Inferior
inferior vena cava thrombectomy renal cell carcinoma complication