Association of an organ transplant-based approach with a dramatic reduction in postoperative complications following radical nephrectomy and tumor thrombectomy in renal cell carcinoma.
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González Javier, Gaynor Jeffrey J, Martínez-Salamanca Juan I, Capitanio Umberto, Tilki Derya, Carballido Joaquín A, Chantada Venancio, Daneshmand Siamak, Evans Christopher P, Gasch Claudia, Gontero Paolo, Haferkamp Axel, Huang William C, Espinós Estefania Linares, Master Viraj A, McKiernan James M, Montorsi Francesco, Pahernik Sascha, Palou Juan, Pruthi Raj S, Rodriguez-Faba Oscar, Russo Paul, Scherr Douglas S, Shariat Shahrokh F, Spahn Martin, Terrone Carlo, Vera-Donoso Cesar, Zigeuner Richard, Hohenfellner Markus, Libertino John A, Ciancio Gaetano
Аннотация
METHODS: A total of 390(292 non-TB/98 TB) IRCC-VT Consortium patients who received no preoperative embolization/IVC filter were included. Stepwise linear/logistic regression analyses were performed to determine significant multivariable predictors of intraoperative estimated blood loss(IEBL), number blood transfusions received, and overall/major PC development within 30days following surgery. Propensity to receive the TB approach was controlled.
RESULTS: The TB approach was clearly superior in limiting IEBL, blood transfusions, and PC development, even after controlling for other significant prognosticators/propensity score(P < .000001 in each case). Median IEBL for non-TB/TB approaches was 1000 cc/300 cc and 1500 cc/500 cc for tumor thrombus Level II-III patients, respectively, with no notable differences for Level IV patients(2000 cc each). In comparing PC outcomes between non-TB/TB patients with a non-Right-Atrium Cranial Limit, the observed percentage developing a: i) PC was 65.8%(133/202) vs. 4.3%(3/69) for ECOG Performance Status(ECOG-PS) 0-1, and 84.8%(28/33) vs. 25.0%(4/16) for ECOG-PS 2-4, and ii) major PC was 16.8%(34/202) vs. 1.4%(1/69) for ECOG-PS 0-1, and 27.3%(9/33) vs. 12.5%(2/16) for ECOG-PS 2-4. Major study limitation was the fact that all TB patients were treated by a single, experienced, high volume surgeon from one center (non-TB patients were treated by various surgeons at 13 other centers).
CONCLUSIONS: Despite this major study limitation, the observed dramatic differences in PC outcomes suggest that the TB approach offers a major breakthrough in limiting operative morbidity in RCC patients receiving RN and TT.