Mp70-12 Is Concomitant Hepatic Resection for Locally Advanced or Metastatic Renal Cell Carcinoma at the Time of Nephrectomy Safe? a Matched Cohort Study
Year: 2015
Type: article
Study design: Observational Study
Abstract: You have accessJournal of UrologyKidney Cancer: Surgical Therapy V1 Apr 2015MP70-12 IS CONCOMITANT HEPATIC RESECTION FOR LOCALLY ADVANCED OR METASTATIC RENAL CELL CARCINOMA AT THE TIME OF NEPHRECTOMY SAFE? A MATCHED COHORT STUDY Sarah Psutka, R. Houston Thompson, Stephen Boorjian, John Cheville, Suzanne Stewart, Christine Lohse, Brian Costello, Florencia Que, and Bradley Leibovich Sarah PsutkaSarah Psutka More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , Stephen BoorjianStephen Boorjian More articles by this author , John ChevilleJohn Cheville More articles by this author , Suzanne StewartSuzanne Stewart More articles by this author , Christine LohseChristine Lohse More articles by this author , Brian CostelloBrian Costello More articles by this author , Florencia QueFlorencia Que More articles by this author , and Bradley LeibovichBradley Leibovich More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2537AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are few reported series regarding outcomes following nephrectomy and simultaneous hepatic resection (HRx) for renal cell carcinoma (RCC) involving the liver. Expert opinion varies regarding the safety and benefit of such aggressive surgical intervention, as some authors suggest that the risks of simultaneous HRx outweigh the benefits. Therefore, we report our experience with simultaneous HRx and nephrectomy. METHODS We identified 34 patients who underwent simultaneous nephrectomy and HRx for direct hepatic invasion or metastasis. These patients (HRx) were matched 1:2 to a cohort undergoing nephrectomy and metastasectomy without hepatic resection according to year, age, and TNM classification (non-HRx, N=68). Perioperative complication rates were compared. Overall survival (OS) was estimated using the Kaplan Meier method. RESULTS In the HRx group, 17 patients underwent HRx for pT4 hepatic involvement and 21 underwent simultaneous hepatic metastasectomy. In the non-HRx group, 38 patients had non-hepatic pT4 disease and 35 underwent metastasectomy for non-hepatic distant metastasis. Median blood loss was higher among HRx (1.6 vs. 1.0 L, p=0.047), with a trend towards increased intraoperative (5 vs. 3 units, p=0.08) and postoperative (6 vs. 4 units, p=0.06) transfusion requirement among HRx. Length of stay was similar (7.5 vs. 7 days, p=0.8) between HRx and non-HRx. The incidence of DVT was significantly higher among the HRx group (15% vs. 1%, p=0.02); however, no statistically significant differences were noted in the rates of Clavien grade 3-4 complications (12% vs. 3%, p=0.1) or perioperative mortality (3% vs. 0%, p=0.7) between those who underwent HRx and those who did not. At last follow-up, 31/34 HRx and 64/68 non-HRx patients had died, including 30 and 60 who died of RCC at a median of 1.2 and 0.9 years, respectively. Two-year OS for HRx and non-HRx were 40% and 28%, (HR 0.80 p=0.30, Figure). CONCLUSIONS In selected patients, aggressive surgical resection of RCC involving the liver does not appear to significantly increase perioperative or overall mortality when compared to matched controls. Moderate/severe complications were more frequent in HRx patients, but this was not statistically significant. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e879-e880 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah Psutka More articles by this author R. Houston Thompson More articles by this author Stephen Boorjian More articles by this author John Cheville More articles by this author Suzanne Stewart More articles by this author Christine Lohse More articles by this author Brian Costello More articles by this author Florencia Que More articles by this author Bradley Leibovich More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
Source: The Journal of Urology
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2059006548