title: Safety of presurgical targeted therapy in the setting of metastatic renal cell carcinoma.
abstract: BACKGROUND
  In patients with metastatic renal cell carcinoma (mRCC), the timing of systemic targeted therapy in relation to cytoreductive nephrectomy (CN) is under investigation.
  
  
  OBJECTIVE
  To evaluate postoperative complications after the use of presurgical targeted therapy prior to CN.
  
  
  METHODS
  A retrospective review of all patients who underwent a CN at The University of Texas M.D. Anderson Cancer Center from 2004 to 2010 was performed. Inclusion in this study required documented evidence of mRCC, with treatment incorporating CN.
  
  
  METHODS
  Patients receiving presurgical systemic targeted therapy prior to CN were compared to those undergoing immediate CN.
  
  
  METHODS
  Complications were assessed using the modified Clavien system for a period of 12 mo postoperatively.
  
  
  CONCLUSIONS
  Presurgical therapy was administered to 70 patients prior to CN (presurgical), while 103 patients had an immediate CN (immediate). A total of 232 complications occurred in 57% of patients (99 of 173). Use of presurgical systemic targeted therapy was predictive of having a complication>90 d postoperatively (p=0.002) and having multiple complications (p=0.013), and it was predictive of having a wound complication (p<0.001). Despite these specific complications, presurgical systemic targeted therapy was not associated with an increased overall complication risk on univariable or multivariate analysis (p=0.064 and p=0.237) and was not predictive for severe (Clavien ≥3) complications (p=0.625). This study is limited by its retrospective nature. As is inherent to any retrospective study reporting on complications, we are limited by reporting bias and the potential for misclassification of specific complications.
  
  
  CONCLUSIONS
  Despite an increased risk for specific wound-related complications, overall surgical complications and the risk of severe complications (Clavien ≥3) are not greater after presurgical targeted therapy in comparison to upfront cytoreductive surgery.
authors.affiliation: Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Brian F
authors.initials: BF
authors.lastname: Chapin
authors.forename: Scott E
authors.initials: SE
authors.lastname: Delacroix
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Culp
authors.forename: Graciela M
authors.initials: GM
authors.lastname: Nogueras Gonzalez
authors.forename: Nizar M
authors.initials: NM
authors.lastname: Tannir
authors.forename: Eric
authors.initials: E
authors.lastname: Jonasch
authors.forename: Pheroz
authors.initials: P
authors.lastname: Tamboli
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000009:adverse effects / Q000401:mortality; D020360:Neoadjuvant Therapy; D009392:Nephrectomy / Q000009:adverse effects / Q000401:mortality; D016017:Odds Ratio; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult