Comprehensive Characterization of the Perioperative Morbidity of Cytoreductive Nephrectomy.
BACKGROUND
Although cytoreductive nephrectomy (CN) has been associated with perioperative morbidity, data are lacking regarding the risk of prolonged length of stay (pLOS) and delay to receipt of systemic therapy (ST).


OBJECTIVE
To evaluate the association of clinicopathologic features with postoperative complications, pLOS, and time to receipt of ST.


DESIGN, SETTING, AND PARTICIPANTS
We evaluated 294 patients with M1 renal cell carcinoma treated between 1990 and 2009.


INTERVENTIONS
CN.


OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Logistic and Cox regressions were used to evaluate associations of clinicopathologic features with 30-d postoperative complications, pLOS (LOS ≥75th percentile), and time to receipt of ST.


RESULTS AND LIMITATIONS
Fifteen (5%) patients experienced at least one Clavien grade ≥3 early complication. Among patients for whom postsurgical ST was recommended, 61% did not receive ST within 60 d, but the delay was surgery-related in only 11%. In multivariable models limited to preoperative features, liver metastases were associated with complications (odds ratio [OR] 3.73, p=0.004) and pLOS (OR 2.46, p=0.03), while a laparoscopic approach was associated with earlier administration of ST (hazard ratio [HR] 5.05, p<0.001). In multivariable models incorporating operative features, intraoperative transfusion was associated with complications (OR 1.14, p<0.001) and pLOS (OR 1.22, p<0.001), while pN1 disease was associated with pLOS (OR 2.12, p=0.049) and delay to ST (HR 0.38, p=0.004). Limitations include the retrospective design and surgical selection bias.


CONCLUSIONS
Overall, 61% of CN patients did not receive timely ST, but only 5% of patients experienced Clavien grade ≥3 complications and the delay to ST was surgery-related in 11%. Liver metastases, intraoperative transfusion, and pN1 disease were independently associated with perioperative morbidity.


PATIENT SUMMARY
We evaluated the morbidity of cytoreductive nephrectomy and identified predictors of unfavorable perioperative outcomes. Although 61% of patients did not receive timely systemic therapy, the rates of complications and surgery-related delay to systemic therapy were low.
['Gershman|Boris|B|', 'Moreira|Daniel M|DM|', 'Boorjian|Stephen A|SA|', 'Lohse|Christine M|CM|', 'Cheville|John C|JC|', 'Costello|Brian A|BA|', 'Leibovich|Bradley C|BC|', 'Thompson|R Houston|RH|']
D000368:Aged D000970:Antineoplastic Agents D001803:Blood Transfusion D002292:Carcinoma, Renal Cell D017024:Chemotherapy, Adjuvant D065426:Cytoreduction Surgical Procedures D005260:Female D006801:Humans D007430:Intraoperative Care D007680:Kidney Neoplasms D010535:Laparoscopy D007902:Length of Stay D008113:Liver Neoplasms D008175:Lung Neoplasms D008197:Lymph Node Excision D008207:Lymphatic Metastasis D008297:Male D059146:Metastasectomy D008875:Middle Aged D009392:Nephrectomy D059035:Perioperative Period D012187:Retroperitoneal Space D012189:Retrospective Studies D061665:Time-to-Treatment
Cytoreductive nephrectomy Systemic therapy Complications Renal cell carcinoma Prolonged hospitalization