MP57-05 PERIOPERATIVE OUTCOMES IN CYTOREDUCTIVE NEPHRECTOMY FOR METASTATIC RENAL CELL CARCINOMA ACCORDING TO CLINICAL STAGE: A POPULATION-BASED ANALYSES

Abstract

You have accessJournal of UrologyKidney Cancer: Advanced1 Apr 2014MP57-05 PERIOPERATIVE OUTCOMES IN CYTOREDUCTIVE NEPHRECTOMY FOR METASTATIC RENAL CELL CARCINOMA ACCORDING TO CLINICAL STAGE: A POPULATION-BASED ANALYSES Toshio Takagi, Toru Sugihara, Hideo Yasunaga, Hiromasa Horiguchi, Kiyohide Fushimi, Tsunenori Kondo, Yukio Homma, and Kazunari Tanabe Toshio TakagiToshio Takagi More articles by this author , Toru SugiharaToru Sugihara More articles by this author , Hideo YasunagaHideo Yasunaga More articles by this author , Hiromasa HoriguchiHiromasa Horiguchi More articles by this author , Kiyohide FushimiKiyohide Fushimi More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , Yukio HommaYukio Homma More articles by this author , and Kazunari TanabeKazunari Tanabe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1780AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives It is important to consider perioperative outcomes when deciding whether cytoreductive nephrectomy (CN) is indicated in patients with mRCC. Although some population based studies analyzed risk factors associated with mortality and morbidity after CN, they had a lack of relation between clinical T stage and perioperative outcomes because of study limitations. We investigated perioperative outcomes after CN according to clinical T stage, and analyzed factors affecting outcomes using Japanese Population database. Methods The Japanese Diagnosis Procedure Combination database from 2007 to 2012 was used to evaluate perioperative outcomes including in-hospital mortality, complications, blood transfusion, anesthesia time, postoperative length of stay (PLOS), and total cost in patients who underwent CN for metastatic renal cell carcinoma, according to clinical T stage. Multivariable regression analyses including gender, age, clinical N stage, hospital volume, type of hospital, Charlson comorbidity index (CCI) and clinical T stage were performed to identify outcome predictors. Results This study enrolled 1,074 patients including 270 with T1, 215 with T2, 479 with T3, and 110 with T4. Age, gender and CCI were not significantly different among the four stages. A low clinical T stage was associated with minimally invasive surgery (p <0.001). The blood transfusion rate, anesthesia time, PLOS, and total cost increased significantly with increasing clinical T stage (all p <0.001). Multivariable regression analyses showed that increasing clinical T stage was significantly associated with unfavorable perioperative outcomes except in-hospital mortality (T4/T1: postoperative complications, OR 2.34; blood transfusion, OR 5.27; anesthesia time, +14%; PLOS, +13.2%; total cost, +13.4%; all p <0.05). Clinical N stage was the only significant predictive factor for in-hospital mortality (N1/N0: OR 3.34, p = 0.004; N2/N0: OR 3.48, p = 0.008). Conclusions Clinical T stage was significantly associated with perioperative outcomes other than in-hospital mortality. Clinical N stage was significantly associated with in-hospital mortality. These results may help surgeons decide indication for CN. Table 2. Surgical outcomes according to clinical T stage Variables T1 T2 T3 T4 p Number 270 215 479 110 In-hospital mortality 9 (3.3%) 5 (2.3%) 14 (2.9%) 8 (7.3%) 0.103 Overall perioperative complications 21 (7.8%) 25 (11.6%) 60 (12.5%) 18 (16.4%) 0.082 Pulmonary embolism 0 (0.0%) 0 (0.0%) 1 (0.2%) 1 (0.9%) 0.260 Cardiacac events 6 (2.2%) 5 (2.3%) 15 (3.1%) 3 (2.7%) 0.876 Stroke 0 (0.0%) 0 (0.0%) 1 (0.2%) 1 (0.9%) 0.260 Pneumonia 1 (0.4%) 0 (0.0%) 2 (0.4%) 1 (0.9%) 0.641 Acute renal failure 1 (0.4%) 0 (0.0%) 3 (0.6%) 1 (0.9%) 0.617 Peritonitis 0 (0.0%) 1 (0.5%) 2 (0.4%) 1 (0.9%) 0.585 Ileus 3 (1.1%) 5 (2.3%) 2 (0.4%) 2 (1.8%) 0.141 Urinary tract infection 0 (0.0%) 4 (1.9%) 6 (1.3%) 0 (0.0%) 0.106 Wound dehiscence 2 (0.7%) 3 (1.4%) 2 (0.4%) 0 (0.0%) 0.392 Sepsis/DIC 4 (1.5%) 4 (1.9%) 15 (3.1%) 6 (5.5%) 0.132 Blood transfusion 37 (13.7%) 75 (34.9%) 220 (45.9%) 62 (56.4%) <0.001 Anesthesia time (median, IQR) 250 (191-310) 275 (220-356) 317 (251-410) 356 (250-450) <0.001 PLOS (median, IQR) 11 (9-17) 13 (9-19) 15 (10-26) 18 (11-36) <0.001 Total cost (US$) (median, IQR) 14539 (11987-18563) 15193 (12356-20282) 16768 (12676-25935) 18682 (15074-29172) <0.001 PLOS: postoperative length of stay,DIC: disseminated intravascular coagulation,IQR: interquartile range © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e642-e643 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Toshio Takagi More articles by this author Toru Sugihara More articles by this author Hideo Yasunaga More articles by this author Hiromasa Horiguchi More articles by this author Kiyohide Fushimi More articles by this author Tsunenori Kondo More articles by this author Yukio Homma More articles by this author Kazunari Tanabe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...