Objective
To assess the safety and utility of more aggressive surgical resection of renal cell
carcinoma involving the liver at the time of nephrectomy.
Materials and Methods
We identified 34 cases at our institution where patients underwent simultaneous nephrectomy
and hepatic resection for direct hepatic invasion (n = 17) or metastatic renal cell
carcinoma (n = 21). Perioperative outcomes and complication rates were compared with
a matched referent cohort (n = 68) undergoing simultaneous nephrectomy and resection
of non-hepatic locally invasive or metastatic disease.
Results
Of the 34 cases, 17 (50%) patients underwent hepatic resection for pT4 liver involvement
and 21 (62%) patients underwent simultaneous nephrectomy and hepatic metastasectomy.
Deep vein thrombosis occurred more frequently following hepatic resection (15% vs
1%, P = .02); however, no significant differences were noted in Clavien grade 3-4 complications
(12% vs 3%, P = .10) or perioperative mortality (3% vs 0%, P = .67). Two-year cancer-specific and overall survival for patients undergoing hepatic
resection and non-hepatic resection were 40% and 29% (hazard ratio: 0.72, P = .2) and 40% and 28% (hazard ratio: 0.80, P = .30), respectively.
Conclusion
In carefully selected patients, hepatic resection at the time of nephrectomy is associated
with a higher risk of deep vein thrombosis and may be associated with a trend toward
an increased risk of short-term Clavien IV complications; however, perioperative and
overall mortality are comparable with those in matched patients undergoing surgical
resection of locally advanced or metastatic disease involving non-hepatic organs.
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Article info
Publication history
Published online: August 18, 2016
Accepted:
August 9,
2016
Received:
April 1,
2016
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
