TY - JOUR
T1 - Association of an organ transplant-based approach with a dramatic reduction in postoperative complications following radical nephrectomy and tumor thrombectomy in renal cell carcinoma
AU - González, Javier
AU - Gaynor, Jeffrey J.
AU - Martínez-Salamanca, Juan I.
AU - Capitanio, Umberto
AU - Tilki, Derya
AU - Carballido, Joaquín A.
AU - Chantada, Venancio
AU - Daneshmand, Siamak
AU - Evans, Christopher P.
AU - Gasch, Claudia
AU - Gontero, Paolo
AU - Haferkamp, Axel
AU - Huang, William C.
AU - Espinós, Estefania Linares
AU - Master, Viraj A.
AU - McKiernan, James M.
AU - Montorsi, Francesco
AU - Pahernik, Sascha
AU - Palou, Juan
AU - Pruthi, Raj S.
AU - Rodriguez-Faba, Oscar
AU - Russo, Paul
AU - Scherr, Douglas S.
AU - Shariat, Shahrokh F.
AU - Spahn, Martin
AU - Terrone, Carlo
AU - Vera-Donoso, Cesar
AU - Zigeuner, Richard
AU - Hohenfellner, Markus
AU - Libertino, John A.
AU - Ciancio, Gaetano
PY - 2019/10
Y1 - 2019/10
N2 - Objectives: Our aim was to determine whether using an organ transplant-based(TB) approach reduces postoperative complications(PCs) following radical nephrectomy(RN) and tumor thrombectomy(TT) in renal cell carcinoma(RCC) patients with level II-IV thrombi. 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.
AB - Objectives: Our aim was to determine whether using an organ transplant-based(TB) approach reduces postoperative complications(PCs) following radical nephrectomy(RN) and tumor thrombectomy(TT) in renal cell carcinoma(RCC) patients with level II-IV thrombi. 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.
KW - Inferior vena cava
KW - Postoperative complications
KW - Renal cell carcinoma
KW - Surgical technique
KW - Tumor thrombus
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U2 - 10.1016/j.ejso.2019.05.009
DO - 10.1016/j.ejso.2019.05.009
M3 - Article
C2 - 31155470
AN - SCOPUS:85066340321
VL - 45
SP - 1983
EP - 1992
JO - Clinical Oncology
JF - Clinical Oncology
SN - 0748-7983
IS - 10
ER -