Association of an organ transplant-based approach with a dramatic reduction in postoperative complications following radical nephrectomy and tumor thrombectomy in renal cell carcinoma
- Creators
- Gonzalez J.
- Gaynor J. J.
- Martinez-Salamanca J. I.
- Capitanio U.
- Tilki D.
- Carballido J. A.
- Chantada V.
- Daneshmand S.
- Evans C. P.
- Gasch C.
- Gontero P.
- Haferkamp A.
- Huang W. C.
- Espinos E. L.
- Master V. A.
- McKiernan J. M.
- Montorsi F.
- Pahernik S.
- Palou J.
- Pruthi R. S.
- Rodriguez-Faba O.
- Russo P.
- Scherr D. S.
- Shariat S. F.
- Spahn M.
- Terrone C.
- Vera-Donoso C.
- Zigeuner R.
- Hohenfellner M.
- Libertino J. A.
- Ciancio G.
- Others:
- Gonzalez, J.
- Gaynor, J. J.
- Martinez-Salamanca, J. I.
- Capitanio, U.
- Tilki, D.
- Carballido, J. A.
- Chantada, V.
- Daneshmand, S.
- Evans, C. P.
- Gasch, C.
- Gontero, P.
- Haferkamp, A.
- Huang, W. C.
- Espinos, E. L.
- Master, V. A.
- Mckiernan, J. M.
- Montorsi, F.
- Pahernik, S.
- Palou, J.
- Pruthi, R. S.
- Rodriguez-Faba, O.
- Russo, P.
- Scherr, D. S.
- Shariat, S. F.
- Spahn, M.
- Terrone, C.
- Vera-Donoso, C.
- Zigeuner, R.
- Hohenfellner, M.
- Libertino, J. A.
- Ciancio, G.
Description
Objectives: Our aim was to determine whether using an organ transplant-based(TB) approach reduces postoperative complications(PCs) following radical nephrectomy(RN) and tumor thrombectomy(TT) in renal cell carcinoma(RCC) patients with level II-IV thrombi. Methods: A total of 390(292 non-TB/98 TB) IRCC-VT Consortium patients who received no preoperative embolization/IVC filter were included. Stepwise linear/logistic regression analyses were performed to determine significant multivariable predictors of intraoperative estimated blood loss(IEBL), number blood transfusions received, and overall/major PC development within 30days following surgery. Propensity to receive the TB approach was controlled. Results: The TB approach was clearly superior in limiting IEBL, blood transfusions, and PC development, even after controlling for other significant prognosticators/propensity score(P < .000001 in each case). Median IEBL for non-TB/TB approaches was 1000 cc/300 cc and 1500 cc/500 cc for tumor thrombus Level II-III patients, respectively, with no notable differences for Level IV patients(2000 cc each). In comparing PC outcomes between non-TB/TB patients with a non-Right-Atrium Cranial Limit, the observed percentage developing a: i) PC was 65.8%(133/202) vs. 4.3%(3/69) for ECOG Performance Status(ECOG-PS) 0–1, and 84.8%(28/33) vs. 25.0%(4/16) for ECOG-PS 2–4, and ii) major PC was 16.8%(34/202) vs. 1.4%(1/69) for ECOG-PS 0–1, and 27.3%(9/33) vs. 12.5%(2/16) for ECOG-PS 2–4. Major study limitation was the fact that all TB patients were treated by a single, experienced, high volume surgeon from one center (non-TB patients were treated by various surgeons at 13 other centers). Conclusions: Despite this major study limitation, the observed dramatic differences in PC outcomes suggest that the TB approach offers a major breakthrough in limiting operative morbidity in RCC patients receiving RN and TT.
Additional details
- URL
- http://hdl.handle.net/11567/989767
- URN
- urn:oai:iris.unige.it:11567/989767
- Origin repository
- UNIGE