To determine the effect of disseminated cancer on peri-operative outcomes following radical nephrectomy.
We conducted a retrospective cohort study of patients undergoing radical nephrectomy for kidney cancer from 2005-2014 using the ACS National Surgical Quality Improvement Program, a multi-institutional prospective registry that captures peri-operative surgical complications. Patients were stratified according to the presence (n=657) or absence (n=7143) of disseminated cancer at the time of surgery. We examined major complications (death, reoperation, cardiac event or neurologic event) within 30 days of surgery. Secondary outcomes included pulmonary, infectious, venous thromboembolic, and bleeding complications, prolonged length of stay, and concomitant procedures (bowel, liver, spleen, pancreas and vascular procedures). Adjusted odds ratio (aOR) and 95% confidence interval (95% CI) were calculated using multivariate logical regression models.
Patients with disseminated cancer were older and more likely to be male, have greater comorbidities, and undergo open surgery. Major complications were more common among patients with disseminated cancer (7.8%) than those without disseminated cancer (3.2%; aOR 2.01, 95% CI 1.46-2.86). Mortality was significantly higher in patients with disseminated cancer (3.2%) than those without disseminated cancer (0.5%; p<0.0001). Pulmonary (aOR 1.68, 95% CI 1.09-2.59), thromboembolic (aOR 1.72, 95% CI 1.01-2.96) and bleeding complications (aOR 2.12, 95% CI 1.73-2.60) were more common among patients with disseminated cancer as was prolonged length of stay (aOR 1.27, 95% CI 1.06-1.53).
Nephrectomy in patients with disseminated cancer is a morbid operation with significant peri-operative mortality. These data may be used for pre-operative counselling of patients undergoing cytoreductive nephrectomy.
Urology. 2016 Jun 09 [Epub ahead of print]
Christopher J D Wallis, Georg Bjarnason, James Byrne, Douglas C Cheung, Azik Hoffman, Girish S Kulkarni, Avery B Nathens, Robert K Nam, Raj Satkunasivam
Department of Surgery, Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada., Department of Medicine, Division of Medical Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada., Department of Surgery, Division of General Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada., Department of Surgery, Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada., Department of Surgery, Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada., Department of Surgery, Division of Urology, Princess Margaret Hospital and University Health Network, University of Toronto, Ontario, Canada., Department of Surgery, Division of General Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada., Department of Surgery, Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada., Department of Surgery, Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada. Electronic address: .