Evaluation of perioperative complications in open and laparoscopic surgery for renal cell cancer with tumor thrombus involvement using the Clavien–Dindo classification. Issue 7 (July 2015)

• Record Type: Journal Article
• Authors: Ebbing, J.; Wiebach, T.; Kempkensteffen, C.; Miller, K.; Bachmann, A.; Günzel, K.; Rieken, M.; Friedersdorff, F.; Baumunk, D.; Weikert, S.
• Is Part Of: European journal of surgical oncology. Volume 41:Issue 7(2015:Jul.)
• Page Start: 941
• Page End: 952
• Publication Date: 2015-07
• Subjects: Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2015.02.009
• Languages: English
• ISSNs: 0748-7983

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Abstract</title> <sec> <title id="sectitle0015">Objective</title> <p id="abspara0010">To identify risk factors for perioperative complications and morbidity in renal cell cancer (RCC) surgery with tumor thrombus invasion (TTI).</p> </sec> <sec> <title id="sectitle0020">Patients and methods</title> <p id="abspara0015">Retrospective single-center analysis of 128 patients who underwent open (n = 97) or laparoscopic (n = 31) radical nephrectomy (NT) for RCC between 1999 and 2010. TTI was at Mayo-Level 0, I, II, III, IV in 88, 7, 10, 4, and 19 cases, respectively. Cavotomy was performed in 27, liver mobilisation in 20, and cardiovascular bypass in 17 patients.</p> </sec> <sec> <title id="sectitle0025">Results</title> <p id="abspara0020">The rate of any early postoperative complication (PC) by Clavien–Dindo classification was 58.6%, while the severe early PC rate was 29.7%. There was a statistically significant difference in multivariate analysis in the incidence of any early PC and of severe early PC by Charlson score (OR:1.584 (95%CI:1.141–2.199), p = 0.006; OR:3.065 (95%CI:1.218–7.714), p = 0.017) and by tumor thrombus level TNM-UICC 2010 <underline>T3a</underline>/T3c (OR:10.668 (95%CI:1.266–89.871), p = 0.029; OR:10.502 (95%CI:2.981–36.992), p < 0.001). In pT3a cases open NT was associated with a higher early (57.9% vs. 25.8%) and severe (24.6% vs. 9.7%) PC rate compared to laparoscopic NT. The 30-day mortality rate was 0%. The 90-day mortality rate was 6.3% but 100% cancer-related. In Cox regression analysis tumor thrombus level was not predictive for overall survival.</p> </sec> <sec> <title id="sectitle0030">Conclusions</title> <p id="abspara0025">The strongest risk factor for early and severe PC in patients with TTI is a supradiaphragmatic tumor thrombus. In cases with severe PC, this fact persists when comparing Mayo-Levels II–III and Level IV. In pT3a cases open NT shows a 2-fold higher early PC rate compared to laparoscopic NT.</p> </sec> </abstract>