Local tumor destruction in renal cell carcinoma-an inpatient population-based study

OBJECTIVES: Local tumor destruction (LTD) is a recommended therapy alternative for localized T1 renal cell carcinoma for patients who are unfit for surgery. We examined patterns of use and complication rates of LTD in a large population-based cohort.

MATERIALS AND METHODS: Overall, data for 5,285 patients undergoing LTD for renal cell carcinoma were extracted from the Nationwide Inpatient Sample database from 2006 to 2010. We assessed patient and hospital characteristics, as well as postoperative complications, using International Classification of Diseases, Ninth Revision codes. The effect of patient and hospital characteristics on peri-interventional complications (overall or specific) was tested using univariable or multivariable logistic regression models.

RESULTS: Most patients were male (61.2%), aged 71 to 80 years (34.9%), and had 3 or more comorbidities (30.6%). Most LTDs were performed at urban (93.5%), teaching (57.7%), and low-volume (75.7%) hospitals. Overall complications were recorded in 15.4% of patients. In multivariable analyses adjusted for clustering, overall complications occurred more frequently in older, sicker patients who were treated at low-volume hospitals (all P<0.05). Similar results were recorded when each complication category was addressed individually.

CONCLUSIONS: In the current population-based cohort, complications of LTD occurred in 1 of 6 patients and were more frequent in individuals with advanced age or multiple comorbidities, or both, especially if LTDs were performed at lower-volume hospitals.