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Nephrectomy and inferior vena cava thrombectomy for renal cell carcinoma among patients with impaired renal function: defining predictors of outcomes.
- Source :
-
ANZ journal of surgery [ANZ J Surg] 2016 Jan-Feb; Vol. 86 (1-2), pp. 44-8. Date of Electronic Publication: 2015 Sep 15. - Publication Year :
- 2016
-
Abstract
- Background: Management of renal cell carcinoma (RCC) with inferior vena cava thrombus (IVCT) is associated with high morbidity. Chronic kidney disease (CKD) is a known risk factor for perioperative complications in many surgical procedures. The objective of this study was to review the association between preoperative CKD (eGFR < 60 mL/min) and post-operative outcomes in patients with RCC and IVCT undergoing radical nephrectomy (RN) and tumour thrombectomy (TT).<br />Methods: A retrospective review of patients with RCC and IVCT treated with RN and TT was carried out. Complications were recorded according to the Clavien-Dindo classification. Multivariable models were fitted using logistic regression analyses for high-grade complications and salvage therapies and linear-regression for intraoperative blood loss (IBL).<br />Results: One hundred and one patients with RCC and IVCT, treated with RN and TT, were identified. Forty per cent of patients had preoperative CKD. Median IBL was higher in CKD arm (2.5 versus 1.6 L, P = 0.04). In a multivariate linear regression analysis, CKD (beta 1.34, P = 0.01) remained an independent predictor of IBL. High-grade complications were more frequent in the CKD group (34% versus 16%, P = 0.09) and in logistic regression analysis, CKD was an independent predictor of high-grade complications (OR 3.33, 95% CI 1.01-10.9). Furthermore, CKD patients were less likely to be considered for salvage therapies (62% versus 38%, P = 0.02).<br />Conclusions: In patients treated with RN and TT, CKD is an independent predictor of perioperative morbidity. This clinical variable should be considered when selecting patients and subsequent efforts should be made to optimize other competing risk factors in order to reduce the incidence of perioperative adverse events in this patient population.<br /> (© 2015 Royal Australasian College of Surgeons.)
- Subjects :
- Aged
Blood Loss, Surgical
Carcinoma, Renal Cell pathology
Carcinoma, Renal Cell physiopathology
Female
Humans
Kidney Neoplasms pathology
Kidney Neoplasms physiopathology
Male
Middle Aged
Retrospective Studies
Risk Factors
Salvage Therapy
Survival Analysis
Treatment Outcome
Vena Cava, Inferior pathology
Carcinoma, Renal Cell surgery
Kidney Neoplasms surgery
Nephrectomy methods
Renal Insufficiency physiopathology
Thrombectomy methods
Vena Cava, Inferior surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1445-2197
- Volume :
- 86
- Issue :
- 1-2
- Database :
- MEDLINE
- Journal :
- ANZ journal of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 26370725
- Full Text :
- https://doi.org/10.1111/ans.13272