Disseminated Cancer Increases Nephrectomy Complication Rate

Disseminated cancer at the time of radical nephrectomy is associated with 2-fold increased odds of major perioperative complications.
Disseminated cancer at the time of radical nephrectomy is associated with 2-fold increased odds of major perioperative complications.

Disseminated cancer increases the likelihood of major perioperative complications, including mortality, among patients undergoing radical nephrectomy for kidney cancer, researchers found.

Using data from the American College of Surgeons National Surgical Quality Improvement Program registry, Raj Satkunasivam, MD, and Christopher J.D. Wallis, MD, of Sunnybrook Health Sciences Centre in Toronto, and colleagues found that patients with disseminated cancer at the time of radical nephrectomy had a significant 2-fold increased odds of major 30-day perioperative complications compared with those who did not have disseminated cancer. Patients with disseminated cancer at the time of surgery had a significant 1.68 1.72, and 2.12 times increased adjusted odds of pulmonary, thromboembolic, and bleeding complications, respectively, according to an online report in Urology. They also had a significantly higher rate of mortality (3.2% vs. 0.5%) and prolonged length of stay (44.9% vs.31.6%), defined as hospital stays greater than the median (4 days from the date of surgery), the investigators reported.

“These data may be used for preoperative counseling of patients undergoing cytoreductive nephrectomy,” Drs Satkunasivam and Wallis and their colleagues concluded.

The retrospective study included 7800 patients who underwent radical nephrectomy for kidney cancer. Of these, 657 had disseminated cancer at the time of surgery. These patients were more likely to be younger (median 62 vs. 63 years), male (70.3% vs. 63.3%), and white (80.7% vs. 77%) compared with patients who did not have disseminated cancer. The patients with disseminated cancer also were more likely to have a lower body mass index  (median 27.8 vs. 29.3 kg/m2) and to be active smokers (24.7% vs. 19.1%).

Among the 657 patients with disseminated cancer—of whom 282 (42.9%) underwent minimally-invasive surgery (MIS) and 375 (57.1%) underwent open nephrectomy—MIS was associated with significantly lower complication rates, the researchers noted. Unmeasured confounders, they pointed out, could explain the observed protective effect of MIS. Patients treated at centers of excellent and by high-volume surgeons may be more likely to undergo MIS, and patients with more favorable tumor characteristics, such as lower stage, are likely selected for MIS, with open surgery reserved for patients who have more advanced disease, the investigators stated.

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