Association of an organ transplant-based approach with a dramatic reduction in postoperative complications following radical nephrectomy and tumor thrombectomy in renal cell carcinoma.

Autor: González J; Department of Urolorgy, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: fcojavier.gonzalez@salud.madrid.org., Gaynor JJ; 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., Martínez-Salamanca JI; Servicio de Urología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain. Electronic address: jims09@me.com., Capitanio U; Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy. Electronic address: umbertocapitanio@gmail.com., Tilki D; Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA, USA. Electronic address: dtilki@me.com., Carballido JA; Servicio de Urología, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain. Electronic address: carballidojoaquin@gmail.com., Chantada V; Servicio de Urología, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain. Electronic address: vchantada@hotmail.com., Daneshmand S; USC/Norris Comprehensive Cancer Center, Los Angeles, CA, USA. Electronic address: daneshma@med.usc.edu., Evans CP; Department of Urology, University of California, Davis, School of Medicine, Sacramento, CA, USA. Electronic address: cpevans@ucdavis.edu., Gasch C; Department of Urology, University of Heidelberg, Heidelberg, Germany. Electronic address: claudia.gasch@med.uni-heidelberg.de., Gontero P; Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy. Electronic address: paolo.gontero@unito.it., Haferkamp A; Department of Urology and Pediatric Urology, Mainz University Medical Center, Mainz, Germany. Electronic address: axel.haferkamp@unimedizin-mainz.de., Huang WC; Department of Urology, New York University Langone School of Medicine, New York, USA. Electronic address: william.huang@nyumc.org., Espinós EL; Department of Urology, Hospital Universitario La Paz, Madrid, Spain. Electronic address: estefanialinares@gmail.com., Master VA; Department of Urology, Emory University, Atlanta, GA, USA. Electronic address: vmaster@emory.edu., McKiernan JM; Department of Urology, Columbia University College of Physicians and Surgeons, New York, USA. Electronic address: jmm23@cumc.columbia.edu., Montorsi F; Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy. Electronic address: montorsi.francesco@hsr.it., Pahernik S; Department of Urology, Paracelsus University Hospital (PMU), Nürnberg, Germany. Electronic address: sascha.pahernik@klinikum-nuernberg.de., Palou J; Department of Urology, Fundació Puigvert, Barcelona, Spain. Electronic address: jpalou@fundacio-puigvert.es., Pruthi RS; Department of Urology, UNC at Chapel Hill, Chapel Hill, NC, USA. Electronic address: raj_pruthi@med.unc.edu., Rodriguez-Faba O; Department of Urology, Fundació Puigvert, Barcelona, Spain. Electronic address: orodriguez@fundacio-puigvert.es., Russo P; Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Electronic address: russop@mskcc.org., Scherr DS; Department of Urology, Weill Cornell Medical Center, New York, USA. Electronic address: dss2001@med.cornell.edu., Shariat SF; Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. Electronic address: sfshariat@gmail.com., Spahn M; Department of Urology, Center of Urology/Prostate Cancer Center Hirslanden, Zürich, Switzerland. Electronic address: martin.spahn@hirslanden.ch., Terrone C; Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy. Electronic address: carlo.terrone@med.uniupo.it., Vera-Donoso C; Hospital Universitario y Politécnico La Fe, Valencia, Spain. Electronic address: cdveradonoso@gmail.com., Zigeuner R; Department of Urology, Medical University of Graz, Graz, Austria. Electronic address: richard.zigeuner@medunigraz.at., Hohenfellner M; Department of Urology, University of Heidelberg, Heidelberg, Germany. Electronic address: markus.hohenfellner@med.uni-heidelberg.de., Libertino JA; Department of Urology, Emerson Hospital-MGH Cancer Center, Boston, MA, USA. Electronic address: john.libertino@outlook.com., Ciancio G; 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.
Jazyk: angličtina
Zdroj: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology [Eur J Surg Oncol] 2019 Oct; Vol. 45 (10), pp. 1983-1992. Date of Electronic Publication: 2019 May 15.
DOI: 10.1016/j.ejso.2019.05.009
Abstrakt: 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.
(Copyright © 2019. Published by Elsevier Ltd.)
Databáze: MEDLINE
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