Metastatic stage vs complications at radical nephrectomy with inferior vena cava thrombectomy |
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| Institution: | 1. Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy;2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada;3. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy;4. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;5. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;6. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy;7. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany;8. Departments of Urology, Weill Cornell Medical College, New York, New York, USA;9. Department of Urology, University of Texas Southwestern, Dallas, Texas, USA;10. Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic;11. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;12. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan;13. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;1. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy;2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada;3. Department of Urology, IRCCS Policlinico San Martino, Genova, Italy;4. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;5. Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy;6. Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy;7. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;8. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;9. Departments of Urology, Weill Cornell Medical College, New York, NY;10. Department of Urology, University of Texas Southwestern, Dallas, TX;11. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic;12. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;13. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan;1. Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany;2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada;3. Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy;4. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;5. Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy;6. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy;7. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;8. Department of Urology, Weill Cornell Medical College, New York, NY;9. Department of Urology, University of Texas Southwestern, Dallas, TX;10. Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan;11. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany;12. Department of Urology, Koc University Hospital, Istanbul, Turkey;1. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada;2. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;3. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;4. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy;5. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy;6. Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy;7. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria;8. Department of Urology, Weill Cornell Medical College, New York, NY;9. Department of Urology, University of Texas Southwestern, Dallas, TX;10. Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic;11. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;12. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan;13. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany;1. Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy;2. Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada;3. Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy;4. Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy;5. Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany;6. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany;7. Departments of Urology, Weill Cornell Medical College, New York, NY;8. Department of Urology, University of Texas Southwestern, Dallas, TX;9. Department of Urology, Second Faculty of Medicine, Charles University, Praga, Czech Republic;10. Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia;11. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan;12. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria |
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| Abstract: | BackgroundTo investigate perioperative complication rates at radical nephrectomy (RN) according to inferior vena cava thrombectomy (IVC-T) status and stage (metastatic vs non-metastatic) within kidney cancer patients.Materials and methodsWe ascertained perioperative complication rates within the National Inpatient Sample database (2016–2019). First, log-link linear Generalized Estimating Equation function (GEE) regression models (adjusted for hospital clustering and weighted for discharge disposition) tested complication rates in IVC-T patients, according to metastatic stage. Subsequently, a subgroup analysis relied on RN patients with or without IVC-T. Here, multivariable logistic regression models tested complication rates in RN patients according to IVC-T status, after propensity score matching including metastatic stage.ResultsOf 26,299 RN patients, 461 (2%) patients underwent IVC-T. Of those, 252 (55%) were non-metastatic vs 209 (45%) were metastatic. Rates of acute kidney injury (AKI), transfusion, cardiac, thromboembolic and other medical complications in non-metastatic vs metastatic patients were 40 vs 40%, 25 vs 22%, 21 vs 23%, 19 vs 14% and 38 vs 40%, respectively (all p ≥ 0.2). Metastatic stage in IVC-T patients did not predict differences in complications in log-link linear GEE regression models (all p > 0.1). However, in logistic regression models with propensity score matching, relying on the overall cohort of RN patients, IVC-T status was associated with higher complication rates (all p < 0.001): AKI (Odds ratio OR]:2.60; 95%-CI 95%-Confidence interval: 1.97–3.44), transfusions (OR:2.40; 95%-CI: 1.72–3.36), cardiac (OR:2.27; 95%-CI: 1.49–3.47), thromboembolic (OR:9.07; 95%-CI: 5.21–16.58) and other medical complications (OR:2.01; 95%-CI: 1.52–2.66).ConclusionsThe current analyses indicate that presence of concomitant IVC-T is associated with higher complication rate at RN. Conversely, metastatic stage has no effect on recorded complication rates. |
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| Keywords: | Inferior vena cava thrombectomy Renal cell carcinoma Radical nephrectomy Perioperative outcome |
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