Perioperative outcomes of cytoreductive nephrectomy in the UK in 2012.

OBJECTIVES: To define the perioperative morbidity and 30-day mortality of cytoreductive nephrectomy (CN) using the British Association of Urological Surgeons (BAUS) nephrectomy dataset for 2012, the first year of public reporting of individual surgeon outcomes in the UK. PATIENTS AND METHODS: All nephrectomies recorded in the database in 2012 were analysed, and cytoreductive cases identified. Outcome measures were: blood loss of >1000 mL, transfusion requirement, intra- and postoperative complications assessed by Clavien-Dindo score, and 30-day mortality (including failure-to-rescue rate). Univariate and multivariate logistic regression analysis was used to assess predictors of adverse outcomes.
RESULTS: In all, 279 cases were undertaken by 141 surgeons in 90 centres. World Health Organization (WHO) Performance Status (PS) was 0 or 1 in 72.4% (202 cases). Open nephrectomy was performed in 59% (163 cases), with the remainder laparoscopic. The conversion rate for laparoscopy was 14% (16 cases). In all, 40 patients underwent preoperative tyrosine-kinase inhibitor treatment. No significant differences in outcome were observed for this group. The 30-day mortality was 1.79%. Intraoperative complications occurred in 11.9% and postoperative complications in 20.8%. Complications of Clavien-Dindo grade ≥ III occurred in 8%. Blood loss of >1000 mL occurred in 15.4% of cases and 24.1% of patients required a perioperative transfusion. Tumour of >10 cm was an independent risk factor for blood loss of >1000 mL (P = 0.021) and intraoperative complications (P = 0.021). The number of metastatic sites was an independent predictor of blood loss of >1000 mL (P = 0.001) and transfusion requirement (P = 0.026) WHO PS of ≥2 was also independently associated with intraoperative complication risk (P = 0.021).
CONCLUSIONS: CN in contemporary UK practice appears to have excellent perioperative outcomes overall. Risk factors for adverse perioperative outcomes include tumours of >10 cm, number of metastatic sites and WHO PS of ≥2. The balance of risk and benefit for CN should be carefully considered for patients with poor PS or extensive metastases.