Ebbing J, Wiebach T, Kempkensteffen C, Miller K, Bachmann A, Günzel K, Rieken M, Friedersdorff F, Baumunk D, Weikert S
University Hospital Charité - Campus Benjamin Franklin, Dept. of Urology, Hindenburgdamm 30, 12203 Berlin, Germany; University Hospital Basel, Dept. of Urology, Spitalstrasse 21, 4031 Basel, Switzerland.
University Hospital Charité - Campus Benjamin Franklin, Dept. of Urology, Hindenburgdamm 30, 12203 Berlin, Germany.
Eur J Surg Oncol. 2015 Jul;41(7):941-52. doi: 10.1016/j.ejso.2015.02.009. Epub 2015 Mar 11.
To identify risk factors for perioperative complications and morbidity in renal cell cancer (RCC) surgery with tumor thrombus invasion (TTI).
Retrospective single-center analysis of 128 patients who underwent open (n = 97) or laparoscopic (n = 31) radical nephrectomy (NT) for RCC between 1999 and 2010. TTI was at Mayo-Level 0, I, II, III, IV in 88, 7, 10, 4, and 19 cases, respectively. Cavotomy was performed in 27, liver mobilisation in 20, and cardiovascular bypass in 17 patients.
The rate of any early postoperative complication (PC) by Clavien-Dindo classification was 58.6%, while the severe early PC rate was 29.7%. There was a statistically significant difference in multivariate analysis in the incidence of any early PC and of severe early PC by Charlson score (OR:1.584 (95%CI:1.141-2.199), p = 0.006; OR:3.065 (95%CI:1.218-7.714), p = 0.017) and by tumor thrombus level TNM-UICC 2010 T3a/T3c (OR:10.668 (95%CI:1.266-89.871), p = 0.029; OR:10.502 (95%CI:2.981-36.992), p < 0.001). In pT3a cases open NT was associated with a higher early (57.9% vs. 25.8%) and severe (24.6% vs. 9.7%) PC rate compared to laparoscopic NT. The 30-day mortality rate was 0%. The 90-day mortality rate was 6.3% but 100% cancer-related. In Cox regression analysis tumor thrombus level was not predictive for overall survival.
The strongest risk factor for early and severe PC in patients with TTI is a supradiaphragmatic tumor thrombus. In cases with severe PC, this fact persists when comparing Mayo-Levels II-III and Level IV. In pT3a cases open NT shows a 2-fold higher early PC rate compared to laparoscopic NT.
确定伴有肿瘤血栓侵犯（TTI）的肾细胞癌（RCC）手术围手术期并发症和发病率的危险因素。
对1999年至2010年间128例行开放性（n = 97）或腹腔镜（n = 31）根治性肾切除术（NT）治疗RCC的患者进行回顾性单中心分析。TTI处于梅奥0级、I级、II级、III级、IV级的分别有88例、7例、10例、4例和19例。27例患者进行了腔静脉切开术，20例进行了肝脏游离，17例进行了体外循环。
根据Clavien-Dindo分类法，术后早期任何并发症（PC）的发生率为58.6%，而严重早期PC的发生率为29.7%。多因素分析显示，Charlson评分在术后早期任何PC和严重早期PC的发生率方面存在统计学显著差异（OR：1.584（95%CI：1.141 - 2.199），p = 0.006；OR：3.065（95%CI：1.218 - 7.714），p = 0.017），肿瘤血栓水平TNM-UICC 2010 T3a/T3c也存在显著差异（OR：10.668（95%CI：1.266 - 89.871），p = 0.029；OR：10.502（95%CI：2.981 - 36.992），p < 0.001）。在pT3a病例中，开放性NT与腹腔镜NT相比，早期（57.9%对25.8%）和严重（24.6%对9.7%）PC发生率更高。30天死亡率为0%。90天死亡率为6.3%，但均与癌症相关。Cox回归分析显示肿瘤血栓水平对总生存期无预测价值。
TTI患者早期和严重PC的最强危险因素是膈上肿瘤血栓。在严重PC病例中，比较梅奥II - III级和IV级时这一情况依然存在。在pT3a病例中，开放性NT与腹腔镜NT相比，早期PC发生率高出2倍。
