Department of Urology, University Hospitals Leuven, Leuven, Belgium.
Department of Urology, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Eur Urol Oncol. 2020 Aug;3(4):523-529. doi: 10.1016/j.euo.2020.04.006. Epub 2020 May 12.
Cytoreductive nephrectomy (CN) plays an important role in the treatment of a subgroup of metastatic renal cell carcinoma (mRCC) patients.
We aimed to evaluate morbidity associated with this procedure and identify potential predictors thereof to aid patient selection for this procedure and potentially improve patient outcomes.
DESIGN, SETTING, AND PARTICIPANTS: Data from 736 mRCC patients undergoing CN at 14 institutions were retrospectively recorded in the Registry for Metastatic RCC (REMARCC).
Logistic regression analysis was used to identify predictors for intraoperative, any-grade (AGCs), low-grade, and high-grade (HGCs) postoperative complications (according to the Clavien-Dindo classification) as well as 30-d readmission rates.
Intraoperative complications were observed in 69 patients (10.9%). Thrombectomy (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.08-1.75, p = 0.009) and adjacent organ removal (OR 2.7, 95% CI 1.38-5.30) were significant predictors of intraoperative complications at multivariable analysis. Two hundred seventeen patients (29.5%) encountered AGCs, while 45 (6.1%) encountered an HGC, of whom 10 (1.4%) died. Twenty-four (3.3%) patients had multiple postoperative complications. Estimated blood loss (EBL; OR 1.49, 95% CI 1.08-2.05, p = 0.01) was a significant predictor of AGCs at multivariable analysis. CN case load (OR 0.13, 95% CI 0.03-0.59, p = 0.009) and EBL (OR 2.93, 95% CI 1.20-7.15, p = 0.02) were significant predictors solely for HGCs at multivariable analysis. Forty-one patients (11.5%) were readmitted within 30 d of surgery. No significant predictors were identified. Results were confirmed in a subanalysis focusing solely on patients treated in the contemporary targeted therapy era.
Morbidity associated with CN is not negligible. Predictors of high-grade postoperative morbidity are predominantly indicators of complex surgery. EBL is a strong predictor of postoperative complications. CN case load correlates with lower high-grade morbidity and highlights the benefit of centralization of complex surgery. However, risks and benefits should be balanced when considering CN in mRCC patients.
We studied patients with metastatic renal cancer to evaluate the outcomes associated with the surgical removal of the primary kidney tumor. We found that this procedure is often complex and adverse events are not uncommon. High intraoperative blood loss and a small number of cases performed at the treating center are associated with a higher rate of postoperative complications.
细胞减灭性肾切除术（CN）在治疗转移性肾细胞癌（mRCC）患者亚群中发挥着重要作用。
我们旨在评估该手术相关的发病率，并确定其潜在的预测因素，以帮助患者选择该手术，并有可能改善患者的预后。
设计、地点和参与者：对 14 个机构的 736 例 mRCC 患者接受 CN 的数据进行了回顾性记录，这些数据来自转移性 RCC 登记处（REMARCC）。
采用逻辑回归分析确定术中、任何分级（AGCs）、低分级和高分级（HGCs）术后并发症（根据 Clavien-Dindo 分类）以及 30 天再入院率的预测因素。
69 例患者（10.9%）发生术中并发症。血栓切除术（比值比 [OR] 1.38，95%置信区间 [CI] 1.08-1.75，p=0.009）和相邻器官切除（OR 2.7，95%CI 1.38-5.30）是多变量分析中术中并发症的显著预测因素。217 例患者（29.5%）发生 AGCs，45 例（6.1%）发生 HGCs，其中 10 例（1.4%）死亡。24 例（3.3%）患者发生多种术后并发症。估计失血量（EBL；OR 1.49，95%CI 1.08-2.05，p=0.01）是多变量分析中 AGCs 的显著预测因素。CN 手术量（OR 0.13，95%CI 0.03-0.59，p=0.009）和 EBL（OR 2.93，95%CI 1.20-7.15，p=0.02）是多变量分析中 HGCs 的唯一显著预测因素。41 例患者（11.5%）术后 30 天内再次入院。未确定显著的预测因素。在仅关注接受当代靶向治疗时代治疗的患者的亚分析中，得到了相同的结果。
CN 相关的发病率不容忽视。术后高分级发病率的预测因素主要是手术复杂性的指标。EBL 是术后并发症的有力预测因素。CN 手术量与较低的高分级发病率相关，突出了将复杂手术集中化的益处。然而，在考虑 mRCC 患者的 CN 时，应权衡风险和获益。
我们研究了患有转移性肾肿瘤的患者，以评估手术切除原发性肾脏肿瘤相关的结果。我们发现，该手术通常很复杂，不良事件并不少见。术中大量失血和治疗中心实施的手术数量较少与术后并发症发生率较高相关。
