title: Operative mortality after nephrectomy for renal cell carcinoma.
abstract: OBJECTIVE
  To study the rate and causes of operative and treatment-related mortality after nephrectomy for renal cell carcinoma (RCC) in Iceland.
  
  
  METHODS
  This retrospective population-based study included all patients who underwent nephrectomy for RCC in Iceland between 1971 and 2000. Patients who died <30 days after the operation were analyzed and compared to those who survived surgery. Disease stage, tumor size, patient age and preoperative American Society of Anesthesiologists classification were compared between the two groups. Autopsy records were examined to determine the causes of death.
  
  
  RESULTS
  During the study period 880 patients were diagnosed with RCC and 575 (65%) of them underwent a nephrectomy, 116 (20%) with palliative intent. Operative mortality (OM) was 2.8% and did not change during the 30-year period. Patients with OM were significantly older than those without (73 vs 64 years, respectively) but disease stage, tumor size, ASA classification and gender were comparable between the groups. OM was comparable for patients operated on with palliative (3.4%) vs. curative (2.6%) intent (ns). Median time of death was 10 days postoperatively but no patient died intraoperatively. Causes of death were peri- and postoperative bleeding in five patients, infection/sepsis in four, arrhythmia in three, acute renal failure in two, pulmonary embolism in one and multiorgan failure in one.
  
  
  CONCLUSIONS
  OM after nephrectomy for RCC has remained low during the past three decades in Iceland. It is most often caused by perioperative bleeding and infections. We find that the low OM in patients with metastases gives support to the use of palliative nephrectomy as a treatment option when other forms of treatment have failed.
authors.affiliation: Department of Urology, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland.
authors.forename: Asgeir
authors.initials: A
authors.lastname: Thoroddsen
authors.forename: Tomas
authors.initials: T
authors.lastname: Gudbjartsson
authors.forename: Eirikur
authors.initials: E
authors.lastname: Jonsson
authors.forename: Thorsteinn
authors.initials: T
authors.lastname: Gislason
authors.forename: Gudmundur Vikar
authors.initials: GV
authors.lastname: Einarsson
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007055:Iceland; D015994:Incidence; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods / Q000401:mortality*; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D015996:Survival Rate