Resident Physician University of Wisconsin School of Medicine and Public Health
Introduction: Few data are available describing perioperative outcomes for cytoreductive nephrectomy (CN) or how changes in patient selection may have impacted modern cohorts. This study investigated factors associated with perioperative outcomes in a multi-institutional cohort of patients treated with CN. Methods: Data was analyzed for metastatic renal cell carcinoma patients treated with CN at 6 tertiary centers from 2005-2019. Outcomes included: Clavien-Dindo complications, mortality, length of hospitalization, and 30-day readmission rate. Multivariable logistic regression was used to evaluate variables associated with perioperative outcomes. Patients were stratified into 3 equal time periods to evaluate changes in outcomes over time. Results: A total of 1,272 patients were treated with CN at 6 centers including 369 (29%) from 2005-2009, 557 (44%) from 2010-2014, and 346 (27%) from 2015-2019. Patients treated in 2015-2019 vs 2005-2009 were less likely to have received pre-surgical systemic therapy (19% vs 26%, p=0.02). Perioperative outcomes are shown in Table. Mortality at 90 days was lower for patients treated in 2015-2019 vs 2005-2009 (5% vs 10%, p=0.02). Patients treated in 2015-2019 vs 2005-2009 had lower overall (22% vs 39%, p<0.001) and major (Clavien-Dindo = 3) complications from surgery (10% vs 16%, p=0.02). Median hospital stay was shorter for patients treated 2015-2019 vs 2005-2009 (4 days vs 5 days, p<0.001) but 30-day readmission rate was also higher (12% vs 7%, p=0.02). On multivariable analysis, patients undergoing CN in 2015-2019 had significantly lower odds of major complications (OR 0.57, 95%CI 0.36-0.90) and 90-day mortality (OR 0.49, 95%CI 0.27-0.89) compared to undergoing CN in 2005-2009. Receipt of presurgical systemic therapy was not associated with increased odds of high-grade complications (OR 0.79, 95%CI 0.52-1.19). Conclusions: In this large multi-institutional study, perioperative complications have significantly decreased over time. Prospective studies should investigate how to further improve outcomes and select patients. SOURCE OF Funding: N/A
