Abstract
Objective
To examine the rates of adverse surgical outcomes in patients undergoing cytoreductive
nephrectomy (CN) compared to patients undergoing radical nephrectomy in the nonmetastatic
setting using a large administrative database.
Methods
Patients in the American College of Surgeons National Surgical Quality Improvement
Program (ACS-NSQIP) who underwent a radical nephrectomy between 2011 and 2016 were
included. Patients were stratified by the preoperative variable of presence or absence
of metastatic cancer. Perioperative outcomes were compared. A multivariable logistic
regression analysis was performed to test the association between patients with metastatic
cancer and perioperative morbidity and 30-day mortality.
Results
There were 15,869 total patients included in this analysis of whom 1322 (8%) patients
had metastatic cancer. Of the entire cohort, the majority of patients were over 60
years old (58%) and 9621 (61%) were male. Seventy-three of the patients were Caucasian.
Patients with metastatic cancer had more minor (P< .01) and major (P< .01) complications, a higher rate of reoperation (P< .01), and a higher rate of unplanned readmissions (P< .01). Finally, the cohort with metastatic cancer had a higher rate of postoperative
30-day mortality (P< .01) than patients without metastatic cancer.
Conclusion
Patients undergoing a CN have significantly worse perioperative outcomes than patients
undergoing a radical nephrectomy without evidence of metastases. Careful surgical
risk stratification and appropriate patient counseling should be undertaken when selecting
candidates for CN.
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Article info
Publication history
Published online: October 23, 2020
Accepted:
October 13,
2020
Received:
March 25,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
