To evaluate factors associated with perioperative outcomes in a multi-institutional cohort of patients treated with CN.
Data was analyzed for metastatic renal cell carcinoma (mRCC) patients treated with CN at 6 tertiary academic centers from 2005-2019. Outcomes included: Clavien-Dindo complications, mortality, length of hospitalization, 30-day readmission rate, and time to systemic therapy. Univariate and multivariable models evaluated associations between outcomes and prognostic variables including the year of surgery.
A total of 1,272 consecutive patients were treated with CN. Patients treated in 2015-2019 vs 2005-2009 had better performance status (p<0.001), higher level of comorbidities (p<0.001), higher pathologic N stage (p=0.04), higher percentage of non-clear cell RCC subtypes (p=0.02), more lymph node dissections (p<0.001), and less frequent pre-surgical therapy (p=0.02). Patients treated in 2015-2019 vs 2005-2009 had lower overall and major complications from surgery, 22% vs 39%, p<0.001 and 10% vs 16%, p=0.02. Mortality at 90 days was higher for patients treated 2005-2009 vs 2015-2019; 10% vs 5%, p=0.02. After multivariable analysis, independent predictors of major complications and 90-day mortality were the surgical time period and presence of thrombus. After multivariable analysis, independent predictors of major complications and 90-day mortality were the surgical time period and presence of tumor thrombus.
In this novel analysis postoperative complications and mortality rates were significantly lower in patients treated within the most recent time period.
Urology. 2023 Sep 08 [Epub ahead of print]
Ashanda R Esdaille, Jose A Karam, Viraj A Master, Philippe E Spiess, Jay D Raman, Pranav Sharma, Daniel D Shapiro, Arighno Das, Wade J Sexton, Logan Zemp, Dattatraya Patil, Glenn O Allen, Surena F Matin, Christopher G Wood, E Jason Abel
Department of Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI., Department of Urology, MD Anderson Cancer Center, Houston, TX; Department of Translational and Molecular Pathology, MD Anderson Cancer Center, Houston, TX., Department of Urology, Emory University and Winship Cancer Institute, Atlanta, GA., Department of Urology, Moffitt Cancer Center, Tampa, FL., Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA., Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX., Department of Urology, MD Anderson Cancer Center, Houston, TX., Department of Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI. Electronic address: .