Predictors for complication in renal cancer surgery: a national register study
DOI:
https://doi.org/10.2340/sju.v58.12356Keywords:
Renal cell carcinoma, Surgery, Complications, Mortality, RegisterAbstract
Objective: Nationwide register data provide unique opportunities for real-world assessment of complications from different surgical methods. This study aimed to assess incidence of, and predictors for, post-operative complications and to evaluate 90-day mortality following different surgical procedures and thermal ablation for renal cell carcinoma (RCC).
Material and methods: All patients undergoing surgical treatment and thermal ablation for RCC in Sweden during 2015–2019 were identified from the National Swedish Kidney Cancer Register. Frequencies and types of post-operative complications were analysed. Logistic regression models were used to identify predictors for 90-day major (Clavien-Dindo grades III–V) complications, including death.
Results: The overall complication rate was 24% (1295/5505), of which 495 (8.7%) were major complications. Most complications occurred following open surgery, of which bleeding and infection were the most common. Twice as many complications were observed in patients undergoing open surgery compared to minimally invasive surgery (20% vs. 10%, P < 0.001). Statistically significant predictors for major complications irrespective of surgical category and technique were American society of anesthiologists (ASA) score, tumour diameter and serum creatinine. Separating radical and partial nephrectomy, surgical technique remained a significant risk factor for major complications. Most complications occurred within the first 20 days. The overall 90-day readmission rate was 6.2%, and 30- and 90-day mortality rates were 0.47% and 1.5%, respectively.
Conclusions: In conclusion, bleeding and infection were the most common major complications after RCC surgery. Twice as many patients undergoing open surgery suffer a major post-operative complication as compared to patients subjected to minimally invasive surgery. General predictors for major complications were ASA score, tumour size, kidney function and surgical technique.
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Ljungberg B, Albiges L, Abu-Ghanem Y, Bedke J, Capitanio U, Dabestani S, et al. European Association of Urology Guidelines on renal cell carcinoma: the 2022 update. Eur Urol. 2022;82:399-410. https://doi.org/10.1016/j.eururo.2022.03.006 DOI: https://doi.org/10.1016/j.eururo.2022.03.006
Campbell SC, Clark PE, Chang SS, Karam JA, Souter L, Uzzo RG. Renal mass and localized renal cancer: evaluation, management, and follow-up: AUA guideline: part I. J Urol. 2021;206(2):199–208. https://doi.org/10.1097/JU.0000000000001911 DOI: https://doi.org/10.1097/JU.0000000000001911
Campbell SC, Uzzo RG, Karam JA, Chang SS, Clark PE, Souter L. renal mass and localized renal cancer: evaluation, management, and follow-up: AUA Guideline: part II. J Urol. 2021;206(2):209–18. https://doi.org/10.1097/JU.0000000000001912 DOI: https://doi.org/10.1097/JU.0000000000001912
Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Fernández-Pello S, et al. European Association of Urology Guidelines on renal cell carcinoma: the 2019 Update. Eur Urol. 2019;75(5):799–810. https://doi.org/10.1016/j.eururo.2019.02.011 DOI: https://doi.org/10.1016/j.eururo.2019.02.011
Psutka SP, Gulati R, Jewett MAS, Fadaak K, Finelli A, Legere L, et al. A clinical decision aid to support personalized treatment selection for patients with clinical T1 renal masses: results from a multi-institutional competing-risks analysis. Eur Urol. 2022;81:576–85. https://doi.org/10.1016/j.eururo.2021.11.002 DOI: https://doi.org/10.1016/j.eururo.2022.02.026
Mitropoulos D, Artibani W, Graefen M, Remzi M, Rouprêt M, Truss M. Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol. 2012;61(2):341–9. https://doi.org/10.1016/j.eururo.2011.10.033 DOI: https://doi.org/10.1016/j.eururo.2011.10.033
Stang A, Büchel C. Renal surgery for kidney cancer in Germany 2005–2006: length of stay, risk of postoperative complications and in-hospital death. BMC Urol. 2014;14:74. https://doi.org/10.1186/1471-2490-14-74 DOI: https://doi.org/10.1186/1471-2490-14-74
Tan HJ, Hafez KS, Ye Z, Wei JT, Miller DC. Postoperative complications and long-term survival among patients treated surgically for renal cell carcinoma. J Urol. 2012;187(1):60–6. https://doi.org/10.1016/j.juro.2011.09.031 DOI: https://doi.org/10.1016/j.juro.2011.09.031
Kim SP, Leibovich BC, Shah ND, Weight CJ, Borah BJ, Han LC, et al. The relationship of postoperative complications with in-hospital outcomes and costs after renal surgery for kidney cancer. BJU Int. 2013;111(4):580–8. https://doi.org/10.1111/j.1464-410X.2012.11122.x DOI: https://doi.org/10.1111/j.1464-410X.2012.11122.x
Thorstenson A, Bergman M, Scherman-Plogell AH, Hosseinnia S, Ljungberg B, Adolfsson J, et al. Tumour characteristics and surgical treatment of renal cell carcinoma in Sweden 2005–2010: a population-based study from the national Swedish kidney cancer register. Scand J Urol. 2014;48(3):231–8. https://doi.org/10.3109/21681805.2013.864698 DOI: https://doi.org/10.3109/21681805.2013.864698
Hjelle KM, Johannesen TB, Beisland C. Postoperative 30-day mortality rates for kidney cancer are dependent on hospital surgical volume: results from a Norwegian population-based study. Eur Urol Focus. 2017;3(2–3):300–7. https://doi.org/10.1016/j.euf.2016.10.001 DOI: https://doi.org/10.1016/j.euf.2016.10.001
Gershman B, Bukavina L, Chen Z, Konety B, Schumache F, Li L, et al. The association of robot-assisted versus pure laparoscopic radical nephrectomy with perioperative outcomes and hospital costs. Eur Urol Focus. 2020;6(2):305–12. https://doi.org/10.1016/j.euf.2018.10.004 DOI: https://doi.org/10.1016/j.euf.2018.10.004
Venkatramani V, Koru-Sengul T, Miao F, Nahar B, Prakash NS, Swain S, et al. A comparison of overall survival and perioperative outcomes between partial and radical nephrectomy for cT1b and cT2 renal cell carcinoma – analysis of a national cancer registry. Urol Oncol. 2018;36(3):90.e9–14. https://doi.org/10.1016/j.urolonc.2017.11.008 DOI: https://doi.org/10.1016/j.urolonc.2017.11.008
Mari A, Antonelli A, Bertolo R, Bianchi G, Borghesi M, Ficarra V, et al. Predictive factors of overall and major postoperative complications after partial nephrectomy: results from a multicenter prospective study (The RECORd 1 project). Eur J Surg Oncol. 2017;43(4):823–30. https://doi.org/10.1016/j.ejso.2016.10.016 DOI: https://doi.org/10.1016/j.ejso.2016.10.016
Larcher A, Fossati N, Tian Z, Boehm K, Meskawi M, Valdivieso R, et al. Prediction of complications following partial nephrectomy: implications for ablative techniques candidates. Eur Urol. 2016;69(4): 676–82. https://doi.org/10.1016/j.eururo.2015.07.003 DOI: https://doi.org/10.1016/j.eururo.2015.07.003
National Swedish Kidney Cancer Register, National Report, 2021. Available from: https://www.cancercentrum.se/samverkan/cancerdiagnoser/urinvagar/njurcancer/kvalitetsregister/ [cited 15 March 2023].
Landberg A, Bruce D, Lindblad P, Ljungberg B, Lundstam S, Thorstenson A, et al. Validation of data quality in the National Swedish Kidney Cancer Register. Scand J Urol. 2021;55(2):142–8. https://doi.org/10.1080/21681805.2021.1885485 DOI: https://doi.org/10.1080/21681805.2021.1885485
Yoon PD, Chalasani V, Woo HH. Use of Clavien-Dindo classification in reporting and grading complications after urological surgical procedures: analysis of 2010 to 2012. J Urol. 2013;190(4):1271–4. https://doi.org/10.1016/j.juro.2013.04.025 DOI: https://doi.org/10.1016/j.juro.2013.04.025
Garisto J, Bertolo R, Dagenais J, Sagalovich D, Fareed K, Fergany A, et al. Robotic versus open partial nephrectomy for highly complex renal masses: comparison of perioperative, functional, and oncological outcomes. Urol Oncol. 2018;36(10):471.e1–9. https://doi.org/10.1016/j.urolonc.2018.06.012 DOI: https://doi.org/10.1016/j.urolonc.2018.06.012
Lawson KA, Saarela O, Abouassaly R, Kim SP, Breau RH, Finelli A. The impact of quality variations on patients undergoing surgery for renal cell carcinoma: a National Cancer Database Study. Eur Urol. 2017;72(3):379–86. https://doi.org/10.1016/j.eururo.2017.04.033 DOI: https://doi.org/10.1016/j.eururo.2017.04.033
Rossi SH, Klatte T, Stewart GD. Quality of life outcomes in patients with localised renal cancer: a literature review. World J Urol. 2018;36(12):1961–72. https://doi.org/10.1007/s00345-018-2415-3 DOI: https://doi.org/10.1007/s00345-018-2415-3
Buffi NM, Saita A, Lughezzani G, Porter J, Dell’Oglio P, Amparore D, et al. Robot-assisted Partial Nephrectomy for Complex (PADUA Score ≥10) tumors: techniques and results from a multicenter experience at four high-volume centers. Eur Urol. 2020;77(1):95–100. https://doi.org/10.1016/j.eururo.2019.03.006 DOI: https://doi.org/10.1016/j.eururo.2019.03.006
Bertolo R, Autorino R, Simone G, Derweesh I, Garisto JD, Minervini A, et al. Outcomes of robot-assisted partial nephrectomy for clinical T2 renal tumors: a multicenter analysis (ROSULA Collaborative Group). Eur Urol. 2018;74(2):226–32. https://doi.org/10.1016/j.eururo.2018.05.004 DOI: https://doi.org/10.1016/j.eururo.2018.08.031
Sood A, Abdollah F, Sammon JD, Kapoor V, Rogers CG, Jeong W, et al. An evaluation of the timing of surgical complications following nephrectomy: data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). World J Urol. 2015;33(12):2031–8. https://doi.org/10.1007/s00345-015-1564-x DOI: https://doi.org/10.1007/s00345-015-1564-x
Kaisa E, Veitonmäki T, Ettala O, Ronkainen H, Isotalo T, Nykopp T, et al. Does every Clavien-Dindo complication matter? A national multi-center study in kidney cancer surgery. Scand J Urol. 2021;55:441–7. DOI: https://doi.org/10.1080/21681805.2021.1960597
Hadjipavlou M, Khan F, Fowler S, Joyce A, Keeley FX, Sriprasad S. Partial vs radical nephrectomy for T1 renal tumours: an analysis from the British Association of Urological Surgeons Nephrectomy Audit. BJU Int. 2016;117(1):62–71. https://doi.org/10.1111/bju.13114 DOI: https://doi.org/10.1111/bju.13114
Liu JJ, Leppert JT, Maxwell BG, Panousis P, Chung BI. Trends and perioperative outcomes for laparoscopic and robotic nephrectomy using the National Surgical Quality Improvement Program (NSQIP) database. Urol Oncol. 2014;32(4):473–9. https://doi.org/10.1016/j.urolonc.2013.09.012 DOI: https://doi.org/10.1016/j.juro.2013.02.1531
Abel EJ, Spiess PE, Margulis V, Master VA, Mann M, Zargar-Shoshtari K, et al. Cytoreductive nephrectomy for renal cell carcinoma with venous tumor thrombus. J Urol. 2017;198(2):281–8. https://doi.org/10.1016/j.juro.2017.03.011 DOI: https://doi.org/10.1016/j.juro.2017.03.011
Mir MC, Derweesh I, Porpiglia F, Zargar H, Mottrie A, Autorino R. Partial nephrectomy versus radical nephrectomy for clinical T1b and T2 renal tumors: a systematic review and meta-analysis of comparative studies. Eur Urol. 2017;71(4):606–17. https://doi.org/10.1016/j.eururo.2016.08.060 DOI: https://doi.org/10.1016/j.eururo.2016.08.060
Roussel E, Campi R, Larcher A, Verbiest A, Antonelli A, Palumbo C, et al. Rates and predictors of perioperative complications in cytoreductive nephrectomy: analysis of the registry for metastatic renal cell carcinoma. Eur Urol Oncol. 2020;3(4):523–9. https://doi.org/10.1016/j.euo.2020.04.006 DOI: https://doi.org/10.1016/j.euo.2020.04.006
Dursun F, Elshabrawy A, Wang H, Rodriguez R, Liss MA, Kaushik D, et al. Survival after minimally invasive vs. open radical nephrectomy for stage I and II renal cell carcinoma. Int J Clin Oncol. 2022;27(6):1068–76. https://doi.org/10.1007/s10147-022-02153-5 DOI: https://doi.org/10.1007/s10147-022-02153-5
Bradshaw AW, Autorino R, Simone G, Yang B, Uzzo RG, Porpiglia F, et al. Robotic partial nephrectomy vs minimally invasive radical nephrectomy for clinical T2a renal mass: a propensity score-matched comparison from the ROSULA (Robotic Surgery for Large Renal Mass) Collaborative Group. BJU Int. 2020;126(1):114–23. https://doi.org/10.1111/bju.15064 DOI: https://doi.org/10.1111/bju.15064
Bukavina L, Bensalah K, Bray F, Carlo M, Challacombe B, Karam JA, et al. Epidemiology of renal cell carcinoma: 2022 update. Eur Urol. 2022;82(5):529–42. https://doi.org/10.1016/j.eururo.2022.08.019 DOI: https://doi.org/10.1016/j.eururo.2022.08.019
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