Cytoreductive nephrectomy for metastatic renal cell carcinoma: a population-based analysis of perioperative outcomes according to clinical stage.
OBJECTIVE
To investigate the perioperative outcomes of cytoreductive nephrectomy according to clinical T stage, and to analyze factors affecting these outcomes.


METHODS
The Japanese Diagnosis Procedure Combination database from 2007 to 2012 was used to evaluate perioperative outcomes including in-hospital mortality, complications, blood transfusion, anesthesia time, postoperative length of stay and total cost in patients who underwent cytoreductive nephrectomy for metastatic renal cell carcinoma, according to clinical T stage. Multivariable regression analyses including sex, age, clinical N stage, hospital volume, type of hospital, Charlson Comorbidity Index and clinical T stage were carried out to identify outcome predictors.


RESULTS
The present study enrolled 1074 patients including 270 with T1, 215 with T2, 479 with T3 and 110 with T4. Age, sex and Charlson Comorbidity Index were not significantly different among the four stages. A low clinical T stage was associated with minimally-invasive surgery (P < 0.001). The blood transfusion rate, anesthesia time, postoperative length of stay and total cost increased significantly with increasing clinical T stage (all P < 0.001). Multivariable regression analyses showed that increasing clinical T stage was significantly associated with unfavorable perioperative outcomes except in-hospital mortality (T4/T1: postoperative complications OR 2.34; blood transfusion OR 5.27; anesthesia time +14%; postoperative length of stay +13.2%; total cost +13.4%; all P < 0.05). Clinical N stage was the only significant predictive factor for in-hospital mortality (N1/N0: OR 3.34, P = 0.004; N2/N0: OR 3.48, P = 0.008).


CONCLUSIONS
Clinical T stage is significantly associated with perioperative outcomes, other than in-hospital mortality, in patients with metastatic renal call carcinoma undergoing cytoreductive nephrectomy. Clinical N stage is significantly associated with in-hospital mortality.
Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
Toshio
T
Takagi
Toru
T
Sugihara
Hideo
H
Yasunaga
Hiromasa
H
Horiguchi
Kiyohide
K
Fushimi
Tsunenori
T
Kondo
Yukio
Y
Homma
Kazunari
K
Tanabe
D000368:Aged; D000758:Anesthesia / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000191:economics / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies
kidney neoplasm; metastasis; nephrectomy; predictor