Predictors of Postoperative Complications in Patients Who Undergo Radical Nephrectomy and IVC Thrombectomy: A Large Contemporary Tertiary Center Analysis

Lue, Kathy; Russell, Christopher; Fisher, John; Kurian, Tony; Agarwal, Gautum; Luchey, Adam; Poch, Michael; Pow‐Sang, Julio M.; Sexton, Wade J.; Spiess, Philippe E.

doi:10.1016/j.clgc.2015.09.007

Cited by 21 publications

(11 citation statements)

References 12 publications

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“…On closer examination it appears conclusive that locally or systemically advanced tumours are accompanied with more postoperative complications, as these tumours potentially are more difficult to remove. Besides this finding, our results are in accordance with current literature, as the ASA score demonstrated to have direct correlation with hospitalization days and the severity of complications for example, in patients with surgical management of hip fractures or in the treatment of renal cell carcinoma [27, 28]. Mani et al [29] compared early complications after RC stratified by the surgical focus and operative case load, as they hypothesized that when surgeons with a clear focus on pelvic surgery handled the cases then there were lower complication rates.…”

Section: Discussionsupporting

confidence: 81%

Influence of Body Mass Index on Clinical Outcome Parameters, Complication Rate and Survival after Radical Cystectomy: Evidence from a Prospective European Multicentre Study

et al. 2018

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Background/Aims/Objectives: To evaluate the influence of body mass index (BMI) on complications and oncological outcomes in patients undergoing radical cystectomy (RC). Methods: Clinical and histopathological parameters of patients have been prospectively collected within the “PROspective MulticEnTer RadIcal Cystectomy Series 2011”. BMI was categorized as normal weight (<25 kg/m²), overweight (≥25–29.9 kg/m²) and obesity (≥30 kg/m²). The association between BMI and clinical and histopathological endpoints was examined. Ordinal logistic regression models were applied to assess the influence of BMI on complication rate and survival. Results: Data of 671 patients were eligible for final analysis. Of these patients, 26% (n = 175) showed obesity. No significant association of obesity on tumour stage, grade, lymph node metastasis, blood loss, type of urinary diversion and 90-day mortality rate was found. According to the American Society of Anesthesiologists score, local lymph node (NT) stage and operative case load patients with higher BMI had significantly higher probabilities of severe complications 30 days after RC (p = 0.037). The overall survival rate of obese patients was superior to normal weight patients (p = 0.019). Conclusions: There is no evidence of correlation between obesity and worse oncological outcomes after RC. While obesity should not be a parameter to exclude patients from cystectomy, surgical settings need to be aware of higher short-term complication risks and obese patients should be counselled accordingly.

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Section: Discussionsupporting

confidence: 81%

Influence of Body Mass Index on Clinical Outcome Parameters, Complication Rate and Survival after Radical Cystectomy: Evidence from a Prospective European Multicentre Study

et al. 2018

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“…To date, most large series of patients with RCC and VTT focused on long-term prognosis rather than perioperative outcomes, predictors about postoperative complications was seldom reported [5][6][7][8]. There were also several drawbacks with previous studies.…”

Section: Introductionmentioning

confidence: 75%

“…Internal validation results showed that the accuracy of this model measured by c-index was 0.794, proving it to be an excellent predictive tool. In fact, Haddad et al [5] have reported a preoperative model for RCC patients with VTT; however, it was only applied for patients with suprahepatic thrombus. To the best of our knowledge, we reported the first preoperative nomogram for prediction of overall postoperative complications in patients with all level thrombus.…”

Section: Discussionmentioning

confidence: 99%

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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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“…The median estimated blood loss was 1900 (IQR 800–3300) ml. For patients with thrombus level ≤ 2 and ≥ 3 (Mayo-level), the blood loss were 1500 (IQR 600–2875) ml and 3000 (IQR 1400–5350) ml, respectively [ 4 ]. Massive transfusion of allogeneic blood may cause bacterial infection, allergic reactions, hemolytic reactions, transfusion-related risks of acute lung injury and viral infections.…”

Section: Introductionmentioning

confidence: 99%

CTCs detection from intraoperative salvaged blood in RCC–IVC thrombus patients by negative enrichment and iFISH identification: a preliminary study

et al. 2021

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Background Intra-operative cell salvage (IOCS) and leukocyte-depleted filter (LDF) are widely used and effective in saving blood. However, the safety issue concerning reinfusion of IOCS–LDF processed blood to renal cell carcinoma (RCC) patients with inferior vena cava (IVC) thrombus were inconclusive for fear of increased risk of cancer metastases. This study intends to analyze the circulating tumor cell (CTC) eliminating effect of IOCS–LDF in 5 RCC–IVC thrombus patients. Methods A novel strategy integrating negative enrichment by immunomagnetic beads and immunostaining-fluorescence in situ hybridization with probes identifying aneuploid of 8 and/or 7 were used to detect CTCs from salvages blood. Blood samples were collected from 4 stages in each patient. Results Of the 5 RCC patients, the number of CTCs decreased (from 3, 4, 10, 7, 3, respectively, to all zero) after IOCS–LDF treatment. The triploid of chromosome 7 and/or chromosome 8 were most common karyotype for RCC patients with IVC thrombus. Tetraploid of chromosome 8 occurred in only one sample and no polypoid (number of chromosome > 4) were found. Conclusion IOCS–LDF might be a promising way of reducing of allogeneic product transfusion based on current preliminary outcome. More convincing conclusions are to be drawn with enlarged sample size and long-term follow-up for patients prognosis.

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Predictors of Postoperative Complications in Patients Who Undergo Radical Nephrectomy and IVC Thrombectomy: A Large Contemporary Tertiary Center Analysis

Cited by 21 publications

References 12 publications

Influence of Body Mass Index on Clinical Outcome Parameters, Complication Rate and Survival after Radical Cystectomy: Evidence from a Prospective European Multicentre Study

Influence of Body Mass Index on Clinical Outcome Parameters, Complication Rate and Survival after Radical Cystectomy: Evidence from a Prospective European Multicentre Study

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

CTCs detection from intraoperative salvaged blood in RCC–IVC thrombus patients by negative enrichment and iFISH identification: a preliminary study

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