Comprehensive Characterization of the Perioperative Morbidity of Cytoreductive Nephrectomy

BackgroundAlthough cytoreductive nephrectomy (CN) has been associated with perioperative morbidity, data are lacking regarding the risk of prolonged length of stay (pLOS) and delay to receipt of systemic therapy (ST).ObjectiveTo evaluate the association of clinicopathologic features with postoperative complications, pLOS, and time to receipt of ST.Design, setting, and participantsWe evaluated 294 patients with M1 renal cell carcinoma treated between 1990 and 2009.InterventionsCN.Outcome measurements and statistical analysisLogistic and Cox regressions were used to evaluate associations of clinicopathologic features with 30-d postoperative complications, pLOS (LOS ≥75th percentile), and time to receipt of ST.Results and limitationsFifteen (5%) patients experienced at least one Clavien grade ≥3 early complication. Among patients for whom postsurgical ST was recommended, 61% did not receive ST within 60 d, but the delay was surgery-related in only 11%. In multivariable models limited to preoperative features, liver metastases were associated with complications (odds ratio [OR] 3.73, p = 0.004) and pLOS (OR 2.46, p = 0.03), while a laparoscopic approach was associated with earlier administration of ST (hazard ratio [HR] 5.05, p < 0.001). In multivariable models incorporating operative features, intraoperative transfusion was associated with complications (OR 1.14, p < 0.001) and pLOS (OR 1.22, p < 0.001), while pN1 disease was associated with pLOS (OR 2.12, p = 0.049) and delay to ST (HR 0.38, p = 0.004). Limitations include the retrospective design and surgical selection bias.ConclusionsOverall, 61% of CN patients did not receive timely ST, but only 5% of patients experienced Clavien grade ≥3 complications and the delay to ST was surgery-related in 11%. Liver metastases, intraoperative transfusion, and pN1 disease were independently associated with perioperative morbidity.Patient summaryWe evaluated the morbidity of cytoreductive nephrectomy and identified predictors of unfavorable perioperative outcomes. Although 61% of patients did not receive timely systemic therapy, the rates of complications and surgery-related delay to systemic therapy were low.