Department of Urology, Mayo Clinic, Rochester, MN, USA.
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
Eur Urol. 2016 Jan;69(1):84-91. doi: 10.1016/j.eururo.2015.05.022. Epub 2015 Jun 1.
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).
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.
CN.
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.
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.
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.
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.
虽然细胞减灭性肾切除术（CN）与围手术期发病率有关，但缺乏关于延长住院时间（pLOS）和接受系统治疗（ST）延迟的风险的数据。
评估临床病理特征与术后并发症、pLOS 和接受 ST 的时间之间的关联。
设计、设置和参与者：我们评估了 1990 年至 2009 年间治疗的 294 例 M1 肾细胞癌患者。
CN。
使用逻辑回归和 Cox 回归评估临床病理特征与 30 天术后并发症、pLOS（LOS≥第 75 百分位数）和接受 ST 的时间之间的关系。
15 名（5%）患者至少经历了一次 Clavien 分级≥3 级的早期并发症。在推荐接受术后 ST 的患者中，61%的患者在 60 天内未接受 ST，但只有 11%的延迟与手术有关。在仅包括术前特征的多变量模型中，肝转移与并发症（优势比[OR]3.73，p=0.004）和 pLOS（OR 2.46，p=0.03）相关，而腹腔镜方法与更早接受 ST 相关（风险比[HR]5.05，p<0.001）。在纳入手术特征的多变量模型中，术中输血与并发症（OR 1.14，p<0.001）和 pLOS（OR 1.22，p<0.001）相关，而 pN1 疾病与 pLOS（OR 2.12，p=0.049）和接受 ST 的延迟（HR 0.38，p=0.004）相关。局限性包括回顾性设计和手术选择偏倚。
总体而言，61%的 CN 患者没有及时接受 ST，但只有 5%的患者经历了 Clavien 分级≥3 级的并发症，且 11%的 ST 延迟与手术有关。肝转移、术中输血和 pN1 疾病与围手术期发病率独立相关。
我们评估了细胞减灭性肾切除术的发病率，并确定了不良围手术期结果的预测因素。尽管 61%的患者没有及时接受系统治疗，但并发症发生率和与手术相关的系统治疗延迟率较低。
