Javier González1, Jeffrey J Gaynor2, Juan I Martínez-Salamanca3, Umberto Capitanio4, Derya Tilki5, Joaquín A Carballido6, Venancio Chantada7, Siamak Daneshmand8, Christopher P Evans9, Claudia Gasch10, Paolo Gontero11, Axel Haferkamp12, William C Huang13, Estefania Linares Espinós14, Viraj A Master15, James M McKiernan16, Francesco Montorsi17, Sascha Pahernik18, Juan Palou19, Raj S Pruthi20, Oscar Rodriguez-Faba21, Paul Russo22, Douglas S Scherr23, Shahrokh F Shariat24, Martin Spahn25, Carlo Terrone26, Cesar Vera-Donoso27, Richard Zigeuner28, Markus Hohenfellner29, John A Libertino30, Gaetano Ciancio31. 1. Department of Urolorgy, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: fcojavier.gonzalez@salud.madrid.org. 2. The Lillian Jean Kaplan Renal Transplant Center and the Miami Transplant Institute, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA. Electronic address: jgaynor@med.miami.edu. 3. Servicio de Urología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain. Electronic address: jims09@me.com. 4. Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy. Electronic address: umbertocapitanio@gmail.com. 5. Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA, USA. Electronic address: dtilki@me.com. 6. Servicio de Urología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain. Electronic address: carballidojoaquin@gmail.com. 7. Servicio de Urología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain. Electronic address: vchantada@hotmail.com. 8. USC/Norris Comprehensive Cancer Center, Los Angeles, CA, USA. Electronic address: daneshma@med.usc.edu. 9. Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA, USA. Electronic address: cpevans@ucdavis.edu. 10. Department of Urology, University of Heidelberg, Heidelberg, Germany. Electronic address: claudia.gasch@med.uni-heidelberg.de. 11. Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy. Electronic address: paolo.gontero@unito.it. 12. Department of Urology and Pediatric Urology, Mainz University Medical Center, Mainz, Germany. Electronic address: axel.haferkamp@unimedizin-mainz.de. 13. Department of Urology, New York University Langone School of Medicine, New York, USA. Electronic address: william.huang@nyumc.org. 14. Department of Urology, Hospital Universitario La Paz, Madrid, Spain. Electronic address: estefanialinares@gmail.com. 15. Department of Urology, Emory University, Atlanta, GA, USA. Electronic address: vmaster@emory.edu. 16. Department of Urology, Columbia University College of Physicians and Surgeons, New York, USA. Electronic address: jmm23@cumc.columbia.edu. 17. Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy. Electronic address: montorsi.francesco@hsr.it. 18. Department of Urology, Paracelsus University Hospital (PMU), Nürnberg, Germany. Electronic address: sascha.pahernik@klinikum-nuernberg.de. 19. Department of Urology, Fundació Puigvert, Barcelona, Spain. Electronic address: jpalou@fundacio-puigvert.es. 20. Department of Urology, UNC at Chapel Hill, Chapel Hill, NC, USA. Electronic address: raj_pruthi@med.unc.edu. 21. Department of Urology, Fundació Puigvert, Barcelona, Spain. Electronic address: orodriguez@fundacio-puigvert.es. 22. Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: russop@mskcc.org. 23. Department of Urology, Weill Cornell Medical Center, New York, USA. Electronic address: dss2001@med.cornell.edu. 24. Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. Electronic address: sfshariat@gmail.com. 25. Department of Urology, Center of Urology/Prostate Cancer Center Hirslanden, Zürich, Switzerland. Electronic address: martin.spahn@hirslanden.ch. 26. Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy. Electronic address: carlo.terrone@med.uniupo.it. 27. Hospital Universitario y Politécnico La Fe, Valencia, Spain. Electronic address: cdveradonoso@gmail.com. 28. Department of Urology, Medical University of Graz, Graz, Austria. Electronic address: richard.zigeuner@medunigraz.at. 29. Department of Urology, University of Heidelberg, Heidelberg, Germany. Electronic address: markus.hohenfellner@med.uni-heidelberg.de. 30. Department of Urology, Emerson Hospital-MGH Cancer Center, Boston, MA, USA. Electronic address: john.libertino@outlook.com. 31. The Lillian Jean Kaplan Renal Transplant Center and the Miami Transplant Institute, Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA. Electronic address: gciancio@med.miami.edu.
Abstract
OBJECTIVES: Our aim was to determine whether using an organ transplant-based(TB) approach reduces postoperative complications(PCs) following radical nephrectomy(RN) and tumor thrombectomy(TT) in renal cell carcinoma(RCC) patients with level II-IV thrombi. METHODS: A total of 390(292 non-TB/98 TB) IRCC-VT Consortium patients who received no preoperative embolization/IVC filter were included. Stepwise linear/logistic regression analyses were performed to determine significant multivariable predictors of intraoperative estimated blood loss(IEBL), number blood transfusions received, and overall/major PC development within 30days following surgery. Propensity to receive the TB approach was controlled. RESULTS: The TB approach was clearly superior in limiting IEBL, blood transfusions, and PC development, even after controlling for other significant prognosticators/propensity score(P < .000001 in each case). Median IEBL for non-TB/TB approaches was 1000 cc/300 cc and 1500 cc/500 cc for tumor thrombus Level II-III patients, respectively, with no notable differences for Level IV patients(2000 cc each). In comparing PC outcomes between non-TB/TB patients with a non-Right-Atrium Cranial Limit, the observed percentage developing a: i) PC was 65.8%(133/202) vs. 4.3%(3/69) for ECOG Performance Status(ECOG-PS) 0-1, and 84.8%(28/33) vs. 25.0%(4/16) for ECOG-PS 2-4, and ii) major PC was 16.8%(34/202) vs. 1.4%(1/69) for ECOG-PS 0-1, and 27.3%(9/33) vs. 12.5%(2/16) for ECOG-PS 2-4. Major study limitation was the fact that all TB patients were treated by a single, experienced, high volume surgeon from one center (non-TB patients were treated by various surgeons at 13 other centers). CONCLUSIONS: Despite this major study limitation, the observed dramatic differences in PC outcomes suggest that the TB approach offers a major breakthrough in limiting operative morbidity in RCC patients receiving RN and TT.
OBJECTIVES: Our aim was to determine whether using an organ transplant-based(TB) approach reduces postoperative complications(PCs) following radical nephrectomy(RN) and tumor thrombectomy(TT) in renal cell carcinoma(RCC) patients with level II-IV thrombi. METHODS: A total of 390(292 non-TB/98 TB) IRCC-VT Consortium patients who received no preoperative embolization/IVC filter were included. Stepwise linear/logistic regression analyses were performed to determine significant multivariable predictors of intraoperative estimated blood loss(IEBL), number blood transfusions received, and overall/major PC development within 30days following surgery. Propensity to receive the TB approach was controlled. RESULTS: The TB approach was clearly superior in limiting IEBL, blood transfusions, and PC development, even after controlling for other significant prognosticators/propensity score(P < .000001 in each case). Median IEBL for non-TB/TB approaches was 1000 cc/300 cc and 1500 cc/500 cc for tumor thrombus Level II-III patients, respectively, with no notable differences for Level IV patients(2000 cc each). In comparing PC outcomes between non-TB/TBpatients with a non-Right-Atrium Cranial Limit, the observed percentage developing a: i) PC was 65.8%(133/202) vs. 4.3%(3/69) for ECOG Performance Status(ECOG-PS) 0-1, and 84.8%(28/33) vs. 25.0%(4/16) for ECOG-PS 2-4, and ii) major PC was 16.8%(34/202) vs. 1.4%(1/69) for ECOG-PS 0-1, and 27.3%(9/33) vs. 12.5%(2/16) for ECOG-PS 2-4. Major study limitation was the fact that all TBpatients were treated by a single, experienced, high volume surgeon from one center (non-TBpatients were treated by various surgeons at 13 other centers). CONCLUSIONS: Despite this major study limitation, the observed dramatic differences in PC outcomes suggest that the TB approach offers a major breakthrough in limiting operative morbidity in RCCpatients receiving RN and TT.
Authors: Laura Horodyski; Javier Gonzalez; Marina M Tabbara; Jeffrey J Gaynor; Maria Rodriguez-Cabero; Felipe Herranz-Amo; Carlos Hernández; Rushi Shah; Gaetano Ciancio Journal: Front Oncol Date: 2022-06-30 Impact factor: 5.738