Introduction: The clinical and operative outcomes of patients undergoing consolidative nephrectomy after systemic immunotherapy is poorly characterized. Thus, we conducted a propensity matched analysis comparing the surgical outcomes after consolidative nephrectomy after systemic immunotherapy vs. patients who received upfront cytoreductive surgery. Methods: In this single-institutional study from a large academic center, we retrospectively analyzed a cohort of patients undergoing surgery in the metastatic (M1) setting from 2015 to 2022. Propensity score matching via the nearest neighbor method was utilized to match patients who received pre-operative immunotherapy vs. upfront surgery based on clinical T-stage, surgical approach (open vs. robotic), gender, age and year of surgery. We identified peri-operative clinical characteristics and 90 day surgical complications, measured on the Clavien-Dindo scale, and quantified differences between the two groups. Group differences were compared using the Wilcoxon Rank-Sum test. Results: After propensity score matching from a larger cohort of patients, 31 pts who received pre-operative systemic immunotherapy were matched to a similar cohort of 78 pts who underwent nephrectomy without pre-operative systemic therapy. Comparing patients who received systemic therapy prior to consolidative surgery vs. upfront surgery, most patients were clinical T-stage T3 or higher [22 (67.7%) vs. 55 (70.5%)], had clear cell histology [24 (80.8%) vs. 63 (77.4%)] and underwent an open surgical approach [18 (58.1%) vs. 55 (70.5%)]. There were no differences in operative duration, blood loos and median length of hospital stay, however the pre-operative immunotherapy group was more likely to be transfused >1u pRBC. There were no statistical differences between the two groups in terms of complications and most complications were minor complications (Clavien I-III) [9 (100.0%) vs. 57 (95.0%)]. The most common complications were infectious and respiratory. Conclusions: In our propensity score matched cohort, nephrectomy after systemic immunotherapy had similar operative characteristics and 90 day post-operative complications. SOURCE OF Funding: No funding
