Skip to main content

Advertisement

SpringerLink
Log in

Mortality and Morbidity After Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma: A Population-Based Study

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To test whether the rates of in-hospital mortality, complications, and transfusions are higher in patients treated with cytoreductive nephrectomy (CNT) for metastatic renal cell carcinoma (mRCC) relative to patients treated with nephrectomy (NT) for non-mRCC.

Methods

We assessed 17,688 patients treated with a NT between years 1999 and 2008, within the Florida Inpatient Database. Chi-square and Student t-tests were used to compare the statistical significance of differences in proportions and means, respectively. Univariable and multivariable logistic regression analyses tested the relationship between surgery type (CNT vs. NT) and three end points: in-hospital mortality, complications, and transfusions.

Results

Overall, 6.0% of patients underwent CNT. The rates of in-hospital mortality, complications, and transfusions were 2.4, 26.5, and 24.3% in CNT patients versus 0.9, 18.9, and 11.1% in NT patients. At multivariable analyses, CNT patients demonstrated a 2.0-, 1.3-, and 2.4-fold higher risk of in-hospital mortality, complications, and transfusions (all P < 0.001). Similarly, more advanced age, comorbidity, and the cumulative number of secondary surgical procedures were independent predictors of a higher risk of in-hospital mortality, complications, and transfusions (all P < 0.001).

Conclusions

The rate of in-hospital mortality, complications, and transfusions is higher in patients treated with CNT relative to NT. Older age, higher comorbidity, and the necessity of secondary surgical procedures further increases the risk of all aforementioned end points. Physicians should consider these observations during the planning of a CNT, and patients should be informed accordingly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. NCCN (2010) NCCN clinical practice guidelines in oncology. Kidney cancer. http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.

  2. Flanigan RC, Salmon SE, Blumenstein BA, et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med. 2001;345:1655–9.

    Article  PubMed  CAS  Google Scholar 

  3. Mickisch GH, Garin A, van Poppel H, et al. Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet. 2001;358:966–70.

    Article  PubMed  CAS  Google Scholar 

  4. Flanigan RC, Mickisch G, Sylvester R, et al. Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol. 2004;171:1071–6.

    Article  PubMed  Google Scholar 

  5. Bennett RT, Lerner SE, Taub HC, et al. Cytoreductive surgery for stage IV renal cell carcinoma. J Urol. 1995;154:32–4.

    Article  PubMed  CAS  Google Scholar 

  6. Fallick ML, McDermott DF, LaRock D, et al. Nephrectomy before interleukin-2 therapy for patients with metastatic renal cell carcinoma. J Urol. 1997;158:1691–5.

    Article  PubMed  CAS  Google Scholar 

  7. Levy DA, Swanson DA, Slaton JW, et al. Timely delivery of biological therapy after cytoreductive nephrectomy in carefully selected patients with metastatic renal cell carcinoma. J Urol. 1998;159:1168–73.

    Article  PubMed  CAS  Google Scholar 

  8. Walther MM, Alexander RB, Weiss GH, et al. Cytoreductive surgery prior to interleukin-2-based therapy in patients with metastatic renal cell carcinoma. Urology. 1993;42:250–7.

    Article  PubMed  CAS  Google Scholar 

  9. Walther MM, Yang JC, Pass HI, et al. Cytoreductive surgery before high dose interleukin-2 based therapy in patients with metastatic renal cell carcinoma. J Urol. 1997;158:1675–8.

    Article  PubMed  CAS  Google Scholar 

  10. Matin SF, Madsen LT, Wood CG. Laparoscopic cytoreductive nephrectomy: the M. D. Anderson Cancer Center experience. Urology. 2006;68:528–32.

    Article  PubMed  Google Scholar 

  11. Goetzl MA, Goluboff ET, Murphy AM, et al. A contemporary evaluation of cytoreductive nephrectomy with tumor thrombus: morbidity and long-term survival. Urol Oncol. 2004;22:182–7.

    Article  PubMed  Google Scholar 

  12. Margulis V, Matin SF, Tannir N, et al. Surgical morbidity associated with administration of targeted molecular therapies before cytoreductive nephrectomy or resection of locally recurrent renal cell carcinoma. J Urol. 2008;180:94–8.

    Article  PubMed  Google Scholar 

  13. Florida Health Finder. http://www.floridahealthfinder.gov/researchers/researchers.aspx. Accessed 14 June 2010.

  14. Statistics. Hysterectomy hospitalizations, 1993–2002. Health outcome series. 2004, p 5. http://edocs.dlis.state.fl.us/fldocs/ahca/Hoseries/hysterectomy_hospitalizations2004.pdf.

  15. Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives. J Clin Epidemiol. 1993;46:1075–9.

    Article  PubMed  CAS  Google Scholar 

  16. Joudi FN, Allareddy V, Kane CJ, et al. Analysis of complications following partial and total nephrectomy for renal cancer in a population based sample. J Urol. 2007;177:1709–14.

    Article  PubMed  Google Scholar 

  17. Jeldres C, Baillargeon-Gagne S, Liberman D, et al. A population-based analysis of the rate of cytoreductive nephrectomy for metastatic renal cell carcinoma in the United States. Urology. 2009;74:837–41.

    Article  PubMed  Google Scholar 

  18. Budaus L, Sun M, Abdollah F, et al. Impact of surgical experience on in-hospital complication rates in patients undergoing minimally invasive prostatectomy: a population-based study. Ann Surg Oncol. 2011;18:839–47.

    Article  PubMed  Google Scholar 

  19. Konety BR, Allareddy V, Herr H. Complications after radical cystectomy: analysis of population-based data. Urology. 2006;68:58–64.

    Article  PubMed  Google Scholar 

  20. Alibhai SM, Leach M, Tomlinson G. Impact of hospital and surgeon volume on mortality and complications after prostatectomy. J Urol. 2008;180:155–62.

    Article  PubMed  Google Scholar 

  21. Begg CB, Riedel ER, Bach PB, et al. Variations in morbidity after radical prostatectomy. N Engl J Med. 2002;346:1138–44.

    Article  PubMed  Google Scholar 

  22. Hu JC, Wang Q, Pashos CL, et al. Utilization and outcomes of minimally invasive radical prostatectomy. J Clin Oncol. 2008;26:2278–84.

    Article  PubMed  Google Scholar 

  23. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111:518–26.

    PubMed  CAS  Google Scholar 

  24. Lawthers AG, McCarthy EP, Davis RB, et al. Identification of in-hospital complications from claims data. Is it valid? Med Care. 2000;38:785–95.

    Article  PubMed  CAS  Google Scholar 

  25. CARMENA. Randomized phase III trial evaluating the importance of nephrectomy in patients presenting with metastatic renal cell carcinoma treated with sunitinib. http://clinicaltrials.gov/ct2/show/NCT00930033?term=renal+cancer&recr=Open&intr=nephrectomy&rank=2 (2009).

  26. EORTC. Randomized Phase III trial comparing presurgical sunitinib followed by nephrectomy and sunitinib versus nephrectomy followed by sunitinib in patients with synchronous metastatic renal cell carcinoma. http://www.eortc.be/protoc/Details.asp?Protocol=30073&T= (2008, updated February 2010).

  27. Halbert R, Figlin R, Atkins M, et al. Treatment of patients with metastatic renal cell cancer. Cancer. 2006;107:2375–83.

    Article  PubMed  CAS  Google Scholar 

  28. Mitchell RE, Lee BT, Cookson MS, et al. Immediate surgical outcomes for radical prostatectomy in the University HealthSystem Consortium Clinical Data Base: the impact of hospital case volume, hospital size and geographical region on 48,000 patients. BJU Int. 2009;104:1442–5.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

Pierre I. Karakiewicz is partially supported by the University of Montreal Health Centre Urology Specialists, Fonds de la Recherche en Sante du Quebec, the University of Montreal Department of Surgery and the University of Montreal Health Centre (CHUM) Foundation.

Author information

Authors and Affiliations

  1. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada

    Firas Abdollah MD, Maxine Sun BSc, Rodolphe Thuret MD, Jan Schmitges MD, Paul Perrotte MD & Pierre I. Karakiewicz MD

  2. Department of Urology, Vita Salute San Raffaele University, Milan, Italy

    Firas Abdollah MD & Francesco Montorsi MD

  3. Department of Urology, University of Montpellier Health Centre, Montpellier, France

    Rodolphe Thuret MD

  4. Martiniclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Jan Schmitges MD

  5. Department of Urology, Weill Medical College of Cornell University, New York, NY, USA

    Shahrokh F. Shariat MD

  6. Department of Urology, University of Montreal Health Centre, Montreal, Canada

    Paul Perrotte MD & Pierre I. Karakiewicz MD

Authors
  1. Firas Abdollah MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maxine Sun BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rodolphe Thuret MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan Schmitges MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shahrokh F. Shariat MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul Perrotte MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francesco Montorsi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Pierre I. Karakiewicz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Firas Abdollah MD.

Additional information

Firas Abdollah and Maxine Sun contributed equally to this work.

Appendix

Appendix

See Tables 5 and 6.

Table 5 Secondary surgical procedures codes based on the International Classification of Diseases, 9th Revision, Clinical Modifications (ICD-9-CM)
Full size table
Table 6 Complications of NT, diagnosis, and procedure codes according to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM)
Full size table

Rights and permissions

Reprints and permissions

About this article

Cite this article

Abdollah, F., Sun, M., Thuret, R. et al. Mortality and Morbidity After Cytoreductive Nephrectomy for Metastatic Renal Cell Carcinoma: A Population-Based Study. Ann Surg Oncol 18, 2988–2996 (2011). https://doi.org/10.1245/s10434-011-1715-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-011-1715-2

Keywords

Search

Navigation