Raised preoperative international normalised ratio (INR) identifies patients at high risk of perioperative death after simultaneous renal and cardiac surgery for tumours involving the peri‐diaphragmatic inferior vena cava and right atrium

Abstract

. (2016). Raised preoperative international normalised ratio (INR) identifies patients at high risk of perioperative death after simultaneous renal and cardiac surgery for tumours involving the peri-diaphragmatic inferior vena cava and right atrium. BJU International. https://doi.org/10.1111/bju.13587 Citing this paperPlease note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections. General rightsCopyright and moral rights for the publications made accessible in the Research Portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognize and abide by the legal requirements associated with these rights.•Users may download and print one copy of any publication from the Research Portal for the purpose of private study or research.•You may not further distribute the material or use it for any profit-making activity or commercial gain •You may freely distribute the URL identifying the publication in the Research Portal Take down policy If you believe that this document breaches copyright please contact librarypure@kcl.ac.uk providing details, and we will remove access to the work immediately and investigate your claim. Background The ability to predict and therefore avoid surgery in those patients likely to die

Guy’s cancer cohort – real world evidence for cancer pathways

“…It helps accelerate evidence generation through providing observational studies that can generate new hypotheses and support policy makers. Prior to its formal development, a wide variety of studies had already been published using the clinical data of GSTT's cancer patients (based on individual ethics or audit approval) including various studies focused on prostate cancer [4][5][6][7][8][9], breast cancer [10][11][12][13] and renal cancer [14]. The below case study shows how data from Guy's Cancer Cohort was used to address a clinically important question for bladder cancer:…”

Surgery for high‐risk locally advanced (pT3c) renal tumours: oncological outcomes and prognostic significance of a modified International Metastatic Renal Cell Cancer Database Consortium (IMDC) score

“…The median survival of the non‐operated patients was 6 months, and they were excluded from further analysis. Three patients died in the first 30 postoperative days (6%) and were excluded from further analysis, as these cases have been reported and explored separately . Oncological and survival outcomes were analysed for the remaining 45 operated patients.…”

“…Surgery was performed by a single surgical team in the cardiothoracic unit of Guy's and St Thomas’ and London Bridge Hospitals, adopting the surgical technique previously reported . Follow‐up was conducted in a dedicated multidisciplinary renal cancer clinic, and typically included clinical review with serial CT imaging every 3 months for the first year, and biannually in the second year.…”

“…Understanding which patients obtain the greatest survival benefit from surgery would be a major step forward, particularly given the fast‐changing landscape of targeted systemic therapies for RCC . Peri‐operative mortality of 6% and up to one‐third of patients experiencing significant postoperative complications has clear implications for consent . We recently reported raised preoperative international normalized ratio as a useful predictor of peri‐operative mortality in this population, but tools for predicting oncological outcomes are still needed .…”

“…Peri‐operative mortality of 6% and up to one‐third of patients experiencing significant postoperative complications has clear implications for consent . We recently reported raised preoperative international normalized ratio as a useful predictor of peri‐operative mortality in this population, but tools for predicting oncological outcomes are still needed . Those patients with poorer prognoses may be better managed with primary systemic treatment or even palliative approaches as an alternative to surgery, while surgical resources could be concentrated on those likely to derive the greatest benefit.…”