Evaluation of perioperative complications in open and laparoscopic surgery for renal cell cancer with tumor thrombus involvement using the Clavien–Dindo classification

Ebbing, Jan; Wiebach, Th.; Kempkensteffen, Carsten; Miller, Kurt; Bachmann, Alexander; Günzel, Karsten; Rieken, Malte; Friedersdorff, Frank; Baumunk, D.; Weikert, Steffen

doi:10.1016/j.ejso.2015.02.009

Cited by 33 publications

(29 citation statements)

References 30 publications

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“…In our cohort between 2015 and 2018, the proportion of level III/IV VTT was 30.9%, which was comparable with these studies (range 14-36%), but we still reported a relatively low level of morbidity and mortality [6,7]. Interestingly, we also found that our major complication rate (12.5%) was much lower than previous reports (range 23-29.7%) but not Grade 1-2 complication rate [6,7]. Higher annual surgery volume facilitated our multidisciplinary team to obtain more experience in perioperative management.…”

Section: Discussionsupporting

confidence: 89%

“…Recent studies still indicated that radical nephrectomy with thrombectomy was associated with major perioperative morbidity (range 50-78%) and mortality (range 2.7-8.3%) [6,7,13]. In our cohort between 2015 and 2018, the proportion of level III/IV VTT was 30.9%, which was comparable with these studies (range 14-36%), but we still reported a relatively low level of morbidity and mortality [6,7].…”

Section: Discussionsupporting

confidence: 86%

“…Therefore, we analyzed preoperative variables in order to evaluate the risk of postoperative complications. Level III/IV VTT, as the most influential preoperative predictor of overall complications, has been reported in several studies [6,7]. There were obvious increases in operation time, blood loss intraoperatively, blood transfusion intraoperatively, length of hospital stay, incidence of postoperative complications as the tumor thrombus level increased (Table 2), which was simi- lar to previous reports [9,15].…”

Section: Discussionsupporting

confidence: 80%

“…This is a retrospective study from single institutional series with limited follow-up data, but the data set was prospectively maintained, which could partly adjust. Due to the rarity of this specific disease and shorter investigated period, our patient sample was not a large number, but comparable with previous studies [6][7][8]. We may underestimate postoperative complications, given the fact that patients discharged from hospital may not always come back for treatment of complications.…”

Section: Discussionmentioning

confidence: 58%

“…And we also believed that more recent series benefited from better medical resources. Besides, we speculated that lower body mass index and more minimal invasive approach may also contribute to lower perioperative morbidity [7]. We recognized no perioperative pulmonary embolism as the reason of this low mortality.…”

Section: Discussionmentioning

confidence: 78%

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A Contemporary High-Volume Center Analysis of Postoperative Complications Following Surgical Management of Renal Cell Carcinoma with Tumor Thrombus

Zhang

Liu

et al. 2019

Urol Int

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Purpose: To define preoperative predictors and construct a preoperative multivariable model for prediction of postoperative complications in patients with renal cell carcinoma (RCC) after nephrectomy with thrombectomy. Materials and Methods: We identified patients with RCC and level I–IV venous tumor thrombus (VTT) who underwent concomitant radical nephrectomy and thrombectomy between February 2015 and March 2018. Univariate and multivariate logistic regression analyses were used to assess the effect of preoperative factors on the incidence of overall and major postoperative complications within 30 days postoperatively. A nomogram for prediction of postoperative complications was also developed using regression coefficients from the multivariable analyses. Results: A total of 120 patients met inclusion criteria. We reported an overall complication rate of 39.2% and major complication rate of 12.5% within 30 days after surgery, with perioperative mortality rate of 2.5%. On multivariate analysis, independent predictors of overall complications included systemic symptoms, comorbidity, level III/IV VTT and serum creatine (SCr) level, while only SCr level was significantly associated with major complications. The internal validation result showed that the accuracy of our preoperative nomogram for overall complications measured by c-index was 0.794. Conclusions: We constructed an accurate preoperative model to predict overall postoperative complications in patients with level I–IV thrombus. External verification is still needed to evaluate its general application.

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