Perioperative Morbidity of Cytoreductive Nephrectomy
Cytoreductive nephrectomy (CN) has been associated with perioperative morbidity, however, data are lacking regarding the risk of prolonged length of stay (pLOS) and delay to receipt of systemic therapy (ST).
Mayo Clinic researchers, first author Robert Thompson, conducted a study published in European Urology to evaluate the association of clinicopathologic features with postoperative complications, pLOS, and time to receipt of ST.
During the study, researchers evaluated 294 patients with M1 renal cell carcinoma treated between 1990 and 2009. Five percent of patients experienced at least one Clavien grade ≥3 early complication. Among patients where postsurgical ST was recommended, 61 percent did not receive ST within 60 days, but the delay was surgery-related in only 11 percent.
In multivariable models limited to preoperative features, liver metastases were associated with complications, while a laparoscopic approach was associated with earlier administration of ST. In multivariable models incorporating operative features, intraoperative transfusion was associated with complications and pLOS, while pN1 disease was associated with pLOS and delay to ST. Limitations include the retrospective design and surgical selection bias.
Mayo Clinic researchers evaluated the morbidity of cytoreductive nephrectomy and identified predictors of unfavorable perioperative outcomes. Although 61 percent of patients did not receive timely systemic therapy, the rates of complications and surgery-related delay to systemic therapy were low.