Metastatic stage vs complications at radical nephrectomy with inferior vena cava thrombectomy.

Abstract

BACKGROUND:

To investigate perioperative complication rates at radical nephrectomy (RN) according to inferior vena cava thrombectomy (IVC-T) status and stage (metastatic vs non-metastatic) within kidney cancer patients.

MATERIALS AND METHODS:

We ascertained perioperative complication rates within the National Inpatient Sample database (2016-2019). First, log-link linear Generalized Estimating Equation function (GEE) regression models (adjusted for hospital clustering and weighted for discharge disposition) tested complication rates in IVC-T patients, according to metastatic stage. Subsequently, a subgroup analysis relied on RN patients with or without IVC-T. Here, multivariable logistic regression models tested complication rates in RN patients according to IVC-T status, after propensity score matching including metastatic stage.

RESULTS:

Of 26,299 RN patients, 461 (2%) patients underwent IVC-T. Of those, 252 (55%) were non-metastatic vs 209 (45%) were metastatic. Rates of acute kidney injury (AKI), transfusion, cardiac, thromboembolic and other medical complications in non-metastatic vs metastatic patients were 40 vs 40%, 25 vs 22%, 21 vs 23%, 19 vs 14% and 38 vs 40%, respectively (all p ≥ 0.2). Metastatic stage in IVC-T patients did not predict differences in complications in log-link linear GEE regression models (all p > 0.1). However, in logistic regression models with propensity score matching, relying on the overall cohort of RN patients, IVC-T status was associated with higher complication rates (all p < 0.001): AKI (Odds ratio [OR]:2.60; 95%-CI [95%-Confidence interval: 1.97-3.44), transfusions (OR:2.40; 95%-CI: 1.72-3.36), cardiac (OR:2.27; 95%-CI: 1.49-3.47), thromboembolic (OR:9.07; 95%-CI: 5.21-16.58) and other medical complications (OR:2.01; 95%-CI: 1.52-2.66).

CONCLUSIONS:

The current analyses indicate that presence of concomitant IVC-T is associated with higher complication rate at RN. Conversely, metastatic stage has no effect on recorded complication rates.

• Authors: Benedikt Hoeh, Rocco Simone Flammia, Lukas Hohenhorst, Gabriele Sorce, Andrea Panunzio, Francesco Chierigo, Nancy Nimer, Zhe Tian, Fred Saad, Michele Gallucci, Alberto Briganti, Shahrokh F Shariat, Markus Graefen, Derya Tilki, Alessandro Antonelli, Carlo Terrone, Luis A Kluth, Andreas Becker, Felix K H Chun, Pierre I Karakiewicz
• Journal: Surgical oncology (Surg Oncol) Vol. 42 Pg. 101783 (Jun 2022) ISSN: 1879-3320 [Electronic] Netherlands
• PMID: 35605557 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Elsevier Ltd. All rights reserved.

Topics

• Acute Kidney Injury (etiology, pathology, surgery)
• Carcinoma, Renal Cell (pathology, surgery)
• Humans
• Kidney Neoplasms (pathology, surgery)
• Nephrectomy (adverse effects)
• Retrospective Studies
• Thrombectomy (adverse effects)
• Treatment Outcome
• Vena Cava, Inferior (pathology, surgery)