Metastatic stage vs complications at radical nephrectomy with inferior vena cava thrombectomy
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Metastatic stage vs complications at radical nephrectomy with inferior vena cava thrombectomy. / Hoeh, Benedikt; Flammia, Rocco Simone; Hohenhorst, Lukas; Sorce, Gabriele; Panunzio, Andrea; Chierigo, Francesco; Nimer, Nancy; Tian, Zhe; Saad, Fred; Gallucci, Michele; Briganti, Alberto; Shariat, Shahrokh F; Graefen, Markus; Tilki, Derya; Antonelli, Alessandro; Terrone, Carlo; Kluth, Luis A; Becker, Andreas; Chun, Felix K H; Karakiewicz, Pierre I.
In: SURG ONCOL, Vol. 42, 101783, 06.2022.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Metastatic stage vs complications at radical nephrectomy with inferior vena cava thrombectomy
AU - Hoeh, Benedikt
AU - Flammia, Rocco Simone
AU - Hohenhorst, Lukas
AU - Sorce, Gabriele
AU - Panunzio, Andrea
AU - Chierigo, Francesco
AU - Nimer, Nancy
AU - Tian, Zhe
AU - Saad, Fred
AU - Gallucci, Michele
AU - Briganti, Alberto
AU - Shariat, Shahrokh F
AU - Graefen, Markus
AU - Tilki, Derya
AU - Antonelli, Alessandro
AU - Terrone, Carlo
AU - Kluth, Luis A
AU - Becker, Andreas
AU - Chun, Felix K H
AU - Karakiewicz, Pierre I
N1 - Copyright © 2022 Elsevier Ltd. All rights reserved.
PY - 2022/6
Y1 - 2022/6
N2 - BACKGROUND: To investigate perioperative complication rates at radical nephrectomy (RN) according to inferior vena cava thrombectomy (IVC-T) status and stage (metastatic vs non-metastatic) within kidney cancer patients.MATERIALS AND METHODS: We ascertained perioperative complication rates within the National Inpatient Sample database (2016-2019). First, log-link linear Generalized Estimating Equation function (GEE) regression models (adjusted for hospital clustering and weighted for discharge disposition) tested complication rates in IVC-T patients, according to metastatic stage. Subsequently, a subgroup analysis relied on RN patients with or without IVC-T. Here, multivariable logistic regression models tested complication rates in RN patients according to IVC-T status, after propensity score matching including metastatic stage.RESULTS: Of 26,299 RN patients, 461 (2%) patients underwent IVC-T. Of those, 252 (55%) were non-metastatic vs 209 (45%) were metastatic. Rates of acute kidney injury (AKI), transfusion, cardiac, thromboembolic and other medical complications in non-metastatic vs metastatic patients were 40 vs 40%, 25 vs 22%, 21 vs 23%, 19 vs 14% and 38 vs 40%, respectively (all p ≥ 0.2). Metastatic stage in IVC-T patients did not predict differences in complications in log-link linear GEE regression models (all p > 0.1). However, in logistic regression models with propensity score matching, relying on the overall cohort of RN patients, IVC-T status was associated with higher complication rates (all p < 0.001): AKI (Odds ratio [OR]:2.60; 95%-CI [95%-Confidence interval: 1.97-3.44), transfusions (OR:2.40; 95%-CI: 1.72-3.36), cardiac (OR:2.27; 95%-CI: 1.49-3.47), thromboembolic (OR:9.07; 95%-CI: 5.21-16.58) and other medical complications (OR:2.01; 95%-CI: 1.52-2.66).CONCLUSIONS: The current analyses indicate that presence of concomitant IVC-T is associated with higher complication rate at RN. Conversely, metastatic stage has no effect on recorded complication rates.
AB - BACKGROUND: To investigate perioperative complication rates at radical nephrectomy (RN) according to inferior vena cava thrombectomy (IVC-T) status and stage (metastatic vs non-metastatic) within kidney cancer patients.MATERIALS AND METHODS: We ascertained perioperative complication rates within the National Inpatient Sample database (2016-2019). First, log-link linear Generalized Estimating Equation function (GEE) regression models (adjusted for hospital clustering and weighted for discharge disposition) tested complication rates in IVC-T patients, according to metastatic stage. Subsequently, a subgroup analysis relied on RN patients with or without IVC-T. Here, multivariable logistic regression models tested complication rates in RN patients according to IVC-T status, after propensity score matching including metastatic stage.RESULTS: Of 26,299 RN patients, 461 (2%) patients underwent IVC-T. Of those, 252 (55%) were non-metastatic vs 209 (45%) were metastatic. Rates of acute kidney injury (AKI), transfusion, cardiac, thromboembolic and other medical complications in non-metastatic vs metastatic patients were 40 vs 40%, 25 vs 22%, 21 vs 23%, 19 vs 14% and 38 vs 40%, respectively (all p ≥ 0.2). Metastatic stage in IVC-T patients did not predict differences in complications in log-link linear GEE regression models (all p > 0.1). However, in logistic regression models with propensity score matching, relying on the overall cohort of RN patients, IVC-T status was associated with higher complication rates (all p < 0.001): AKI (Odds ratio [OR]:2.60; 95%-CI [95%-Confidence interval: 1.97-3.44), transfusions (OR:2.40; 95%-CI: 1.72-3.36), cardiac (OR:2.27; 95%-CI: 1.49-3.47), thromboembolic (OR:9.07; 95%-CI: 5.21-16.58) and other medical complications (OR:2.01; 95%-CI: 1.52-2.66).CONCLUSIONS: The current analyses indicate that presence of concomitant IVC-T is associated with higher complication rate at RN. Conversely, metastatic stage has no effect on recorded complication rates.
KW - Acute Kidney Injury/etiology
KW - Carcinoma, Renal Cell/pathology
KW - Humans
KW - Kidney Neoplasms/pathology
KW - Nephrectomy/adverse effects
KW - Retrospective Studies
KW - Thrombectomy/adverse effects
KW - Treatment Outcome
KW - Vena Cava, Inferior/pathology
U2 - 10.1016/j.suronc.2022.101783
DO - 10.1016/j.suronc.2022.101783
M3 - SCORING: Journal article
C2 - 35605557
VL - 42
JO - SURG ONCOL
JF - SURG ONCOL
SN - 0960-7404
M1 - 101783
ER -
