Rates and Predictors of Perioperative Complications in Cytoreductive Nephrectomy: Analysis of the Registry for Metastatic Renal Cell Carcinoma

Abstract

Background: Cytoreductive nephrectomy (CN) plays an important role in the treatment of a subgroup of metastatic renal cell carcinoma (mRCC) patients. Objective: We aimed to evaluate morbidity associated with this procedure and identify potential predictors thereof to aid patient selection for this procedure and potentially improve patient outcomes. Design, setting, and participants: Data from 736 mRCC patients undergoing CN at 14 institutions were retrospectively recorded in the Registry for Metastatic RCC (REMARCC). Outcome measurements and statistical analysis: Logistic regression analysis was used to identify predictors for intraoperative, any-grade (AGCs), low-grade, and high-grade (HGCs) postoperative complications (according to the Clavien-Dindo classification) as well as 30-d readmission rates. Results and limitations: Intraoperative complications were observed in 69 patients (10.9%

Nephrectomy improves the survival of metastatic renal cell cancer patients with moderate to good performance status—results from a Finnish nation-wide population-based study from 2005 to 2010

“…Also, an increased risk of in-hospital mortality (3.6%) for older (≥ 71 years of age) patients was documented, compared to 1.7% and 1.0% in the age groups of 56–70 years and ≤ 55 years, respectively [ 31 ]. Our observed 30-day postoperative mortality was higher than in the recent REMARCC study, which reported 10 (1.3%) deaths and 45 (6.1%) high-grade complications from 736 CNs performed in 14 European institutes [ 32 ]. In our data, it is noteworthy that 6 of the 19 total grade 5 complications did not occur during the first 30-day postoperative period.…”

Management of local recurrence after radical nephrectomy: surgical removal with or without systemic treatment is still the gold standard. Results from a multicenter international cohort

“…Unfortunately, literature has a lack of studies focusing on the effect of surgeon and center volume on LRS outcomes. However, we could expect better surgical outcomes in high-volume vs. low-volume centers, as have been previously reported for cytoreductive nephrectomy [ 16 ]. It is also worth considering the high variability among series in terms of complication reports.…”

Development of a Novel Risk Score to Select the Optimal Candidate for Cytoreductive Nephrectomy Among Patients with Metastatic Renal Cell Carcinoma. Results from a Multi-institutional Registry (REMARCC)

“…On the recently published REMARCC data registry, the overall complication rate for CN was 30%, with only 6% being reported as major complications (grade 3-5 Clavien-Dindo). Less than 12% of the patients were readmitted within 30 d of surgery [7].…”

“…A retrospective review of patients diagnosed with mRCC was abstracted from the Registry for Metastatic RCC (REMARCC) database. The REMARCC collected data on patients who underwent CN between 2005 and 2019 from 14 North American and European institutions [7]. Institutional Board approval was obtained at all participating institutions when required.…”

“…The concordance index (C-index) and its 95% confidence interval (CI) were estimated and internally validated based on 300 bootstraps as a measure of the 36-mo OM discriminative power of the model. Fourth, decision curve analyses (DCAs) were used to compare the net benefit derived from the use of our model with that from IMDC/MSKCC categories (Fig.1)[7]. Fifth, our population was stratified according to the number of risk factors harbored by each patient in three subgroups, namely, those with favorable (no risk factors), intermediate (one or two risk factors), or poor (more than two risk factors) prognosis.…”