1767 POST-OPERATIVE COMPLICATIONS FROM CYTOREDUCTIVE NEPHRECTOMY AFTER PRE-SURGICAL TARGETED THERAPY FOR METASTATIC RENAL CELL CARCINOMA

Abstract

You have accessJournal of UrologyKidney Cancer: Advanced1 Apr 20111767 POST-OPERATIVE COMPLICATIONS FROM CYTOREDUCTIVE NEPHRECTOMY AFTER PRE-SURGICAL TARGETED THERAPY FOR METASTATIC RENAL CELL CARCINOMA Brian F. Chapin, Scott E. Delacroix, Stephen H. Culp, Graciela M. Nogueras-Gonzalez, Nizar Tannir, Eric Jonasch, Pheroz Tamboli, and Christopher G. Wood Brian F. ChapinBrian F. Chapin Houston, TX More articles by this author , Scott E. DelacroixScott E. Delacroix Houston, TX More articles by this author , Stephen H. CulpStephen H. Culp Houston, TX More articles by this author , Graciela M. Nogueras-GonzalezGraciela M. Nogueras-Gonzalez Houston, TX More articles by this author , Nizar TannirNizar Tannir Houston, TX More articles by this author , Eric JonaschEric Jonasch Houston, TX More articles by this author , Pheroz TamboliPheroz Tamboli Houston, TX More articles by this author , and Christopher G. WoodChristopher G. Wood Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2095AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Pre-surgical treatment of metastatic renal cell carcinoma (RCC) with targeted systemic therapies is under investigation. Use of these agents may be associated with a greater risk of surgical complications. We assessed post-operative complications after upfront cytoreductive nephrectomy (CRN) and compared to complications occurring after the use of pre-surgical therapy followed by CRN. METHODS A retrospective review was performed on all patients with clinical evidence of metastasis treated at our institution with CRN from 1/2004 to 3/2010. Of 221 surgical patients, 69 had received pre-operative systemic therapy and were available for review. Outcomes were compared to a cohort of 96 consecutive patients treated with upfront CRN over the same time period. Peri-operative characteristics were recorded for each patient. Surgical complications occurring within 365 days of CRN were assessed by time, event, and classified by the modified Clavien system. Superficial skin dehiscence, wound infection, and fascial dehiscence were classified as wound complications. Predictors of complications were analyzed by univariate analysis and confirmed by use of a multivariate regression model. RESULTS Complications occurred in 55% (91/165) of patients within 365 days of CRN. The most common occurrences were wound complications (28.6%: 26/91), ileus (14.3%: 13/91), acute renal failure (12.1%: 11/91) and chylous ascites (12.1%: 11/91). On univariate analysis, pre-surgical therapy was the only significant predictor of having a wound complication (p=0.001). After accounting for known predictors of wound complications (BMI, smoking status, and diabetes), pre-surgical therapy remained a significant predictor of wound complications (OR 4.7; CI 1.8–12.3). Clavien Grade ≥3 complications occurred in 37% (62/165) of patients. Pre-surgical therapy prior to CRN was a predictor of any complication on univariate analysis, but did not remain significant on multivariate analysis. Specifically, pre-surgical therapy prior to CRN did not predict for Clavien ≥3 complications (p=0.565). Of note, late events (>90 days) were more common in patients who had received pre-surgical therapy (p=0.023). CONCLUSIONS Complications requiring intervention (Clavien ≥3) occur at the same rate between patients receiving pre-surgical therapy prior to CRN and those having up-front CRN. However, patients treated with pre-surgical targeted therapy have an increased risk of wound complications which may present remotely from the time of surgery. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e709 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian F. Chapin Houston, TX More articles by this author Scott E. Delacroix Houston, TX More articles by this author Stephen H. Culp Houston, TX More articles by this author Graciela M. Nogueras-Gonzalez Houston, TX More articles by this author Nizar Tannir Houston, TX More articles by this author Eric Jonasch Houston, TX More articles by this author Pheroz Tamboli Houston, TX More articles by this author Christopher G. Wood Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...