A Contemporary High-Volume Center Analysis of Postoperative Complications Following Surgical Management of Renal Cell Carcinoma with Tumor Thrombus

Abstract

Purpose: To define preoperative predictors and construct a preoperative multivariable model for prediction of postoperative complications in patients with renal cell carcinoma (RCC) after nephrectomy with thrombectomy. Materials and Methods: We identified patients with RCC and level I–IV venous tumor thrombus (VTT) who underwent concomitant radical nephrectomy and thrombectomy between February 2015 and March 2018. Univariate and multivariate logistic regression analyses were used to assess the effect of preoperative factors on the incidence of overall and major postoperative complications within 30 days postoperatively. A nomogram for prediction of postoperative complications was also developed using regression coefficients from the multivariable analyses. Results: A total of 120 patients met inclusion criteria. We reported an overall complication rate of 39.2% and major complication rate of 12.5% within 30 days after surgery, with perioperative mortality rate of 2.5%. On multivariate analysis, independent predictors of overall complications included systemic symptoms, comorbidity, level III/IV VTT and serum creatine (SCr) level, while only SCr level was significantly associated with major complications. The internal validation result showed that the accuracy of our preoperative nomogram for overall complications measured by c-index was 0.794. Conclusions: We constructed an accurate preoperative model to predict overall postoperative complications in patients with level I–IV thrombus. External verification is still needed to evaluate its general application.