Presentation Authors: Riccardo Campi*, Florence, Italy, Maximilian C. Kriegmair, Mannheim, Germany, Riccardo Bertolo, Cleveland, OH, Tobias Klatte, Bournemouth, United Kingdom, Jose Rubio, Valencia , Spain, Tobias Maurer, Munich, Germany, Siska Van Bruwaene, Kortrijk, Belgium, Estefania Linares, Vital Hevia, Madrid, Spain, Mireia Musquera, Barcellona, Spain, Ithaar Derweesh, Louisiana Jolla, CA, Georgi Guruli, Richmond, VA, Eduard Rousel, Maarteen Albertsen, Leuven, Belgium, Nicola Pavan, Francesco Claps, Trieste, Italy, Alessandro Antonelli, Brescia, Italy, Shudong Zhang, Lulin Ma, Beijing, China, People's Republic of, Riccardo Autorino, Richmond, VA, Francesco Porpiglia, Torino, Italy, Umberto Capitanio, Milano, Italy, Andrea Minervini, Firenze, Italy, Maria Carmen Mir, Valencia , Spain
Introduction: The role of cytoreductive nephrectomy (CN) in the setting of metastatic renal cellcarcinoma (mRCC) is still object of great debate within the Urology community. In thisregard, assessing the harms of CN is key to select patients most likely to benefit from thisprocedure.The aim of the study was to evaluate potential predictors of major complications (MC) afterCN in a multicentre international cohort of patients with mRCC.
Methods: Data from patients with mRCC undergoing CN at 11 centers included in the REgistry ofMetAstatic RCC (REMARCC) from January 2014 to December 2017 were retrospectivelycollected and analyzed. Patients with complete data on comorbidity profiles, intraoperativeoutcomes and perioperative complications formed the analytic cohort. Postoperativecomplications were assessed and graded using the modified Clavien-Dindo scale.MCs were defined as Clavien-Dindo grade 3 or more. Multivariable logistic regressionanalysis was used to assess potential clinical predictors of 30-day readmission.
Results: Overall, 374 patients were included in the study. Twenty-three patients (6.1%) experiencedMCs.Patient age, sex, BMI, Charlson comorbidity index, ECOG performance status, baselineHb levels, estimated glomerular filtration rate, cT and cN status, as well as location ofmetastatic lesions, were comparable among patients who did and did not experience MCs.Conversely, median tumor size was significantly higher in patients experiencing MCs (11,0vs 8,5 cm, p=0.002). Surgical approach was significantly different in the two study groups(87.0% of patients who experienced MCs were treated with open CN as compared to65.4% of patients who did not; p=0.034).Performance of LDN was comparable among the study groups; on the contrary, removal ofadjacent organs (43.5 % vs 23.4%, p=0.03), renal vein/vena cava thrombectomy (43.5%vs 17.4%, p=0.002) and metastasectomy at the time of CN (21.7% vs 7.1%, p=0.012)were significantly higher in patients who experienced MCs.Rate of hospital readmission within 30 days after surgery was significantly higher inpatients who experienced MCs (11.1% vs 6.7%, p<0.0001), as well as length ofhospitalization (14 vs 7 days, p=0.003). pT status was also significantly different amongthe study groups (p=0.014)._x000D_
At multivariable analysis, increasing tumor size, performance of metastasectomy at thetime of CN and of renal vein/vena cava thrombectomy were found to be significantlyassociated with MCs in our study cohort.
Conclusions: Performance of metastasectomy and need for renal vein/vena cava thrombectomy maysignificantly impact on the risk of major complications after CN and should be carefullyconsidered in the preoperative surgical planning. The main study limitation is theretrospective design with risk of selection and attrition bias.