title: Evaluation of perioperative complications in open and laparoscopic surgery for renal cell cancer with tumor thrombus involvement using the Clavien-Dindo classification.
abstract: OBJECTIVE
  To identify risk factors for perioperative complications and morbidity in renal cell cancer (RCC) surgery with tumor thrombus invasion (TTI).
  
  
  METHODS
  Retrospective single-center analysis of 128 patients who underwent open (n = 97) or laparoscopic (n = 31) radical nephrectomy (NT) for RCC between 1999 and 2010. TTI was at Mayo-Level 0, I, II, III, IV in 88, 7, 10, 4, and 19 cases, respectively. Cavotomy was performed in 27, liver mobilisation in 20, and cardiovascular bypass in 17 patients.
  
  
  RESULTS
  The rate of any early postoperative complication (PC) by Clavien-Dindo classification was 58.6%, while the severe early PC rate was 29.7%. There was a statistically significant difference in multivariate analysis in the incidence of any early PC and of severe early PC by Charlson score (OR:1.584 (95%CI:1.141-2.199), p = 0.006; OR:3.065 (95%CI:1.218-7.714), p = 0.017) and by tumor thrombus level TNM-UICC 2010 T3a/T3c (OR:10.668 (95%CI:1.266-89.871), p = 0.029; OR:10.502 (95%CI:2.981-36.992), p < 0.001). In pT3a cases open NT was associated with a higher early (57.9% vs. 25.8%) and severe (24.6% vs. 9.7%) PC rate compared to laparoscopic NT. The 30-day mortality rate was 0%. The 90-day mortality rate was 6.3% but 100% cancer-related. In Cox regression analysis tumor thrombus level was not predictive for overall survival.
  
  
  CONCLUSIONS
  The strongest risk factor for early and severe PC in patients with TTI is a supradiaphragmatic tumor thrombus. In cases with severe PC, this fact persists when comparing Mayo-Levels II-III and Level IV. In pT3a cases open NT shows a 2-fold higher early PC rate compared to laparoscopic NT.
authors.affiliation: University Hospital Charité - Campus Benjamin Franklin, Dept. of Urology, Hindenburgdamm 30, 12203 Berlin, Germany; University Hospital Basel, Dept. of Urology, Spitalstrasse 21, 4031 Basel, Switzerland. Electronic address: jan.ebbing@usb.ch.
authors.forename: J
authors.initials: J
authors.lastname: Ebbing
authors.affiliation: University Hospital Charité - Campus Benjamin Franklin, Dept. of Urology, Hindenburgdamm 30, 12203 Berlin, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Wiebach
authors.affiliation: University Hospital Charité - Campus Benjamin Franklin, Dept. of Urology, Hindenburgdamm 30, 12203 Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kempkensteffen
authors.affiliation: University Hospital Charité - Campus Benjamin Franklin, Dept. of Urology, Hindenburgdamm 30, 12203 Berlin, Germany; University Hospital Charité - Campus Mitte, Dept. of Urology, Chariteplatz 1, 10117 Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Miller
authors.affiliation: University Hospital Basel, Dept. of Urology, Spitalstrasse 21, 4031 Basel, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Bachmann
authors.affiliation: University Hospital Charité - Campus Benjamin Franklin, Dept. of Urology, Hindenburgdamm 30, 12203 Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Günzel
authors.affiliation: University Hospital Basel, Dept. of Urology, Spitalstrasse 21, 4031 Basel, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Rieken
authors.affiliation: University Hospital Charité - Campus Mitte, Dept. of Urology, Chariteplatz 1, 10117 Berlin, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Friedersdorff
authors.affiliation: University Hospital Charité - Campus Benjamin Franklin, Dept. of Urology, Hindenburgdamm 30, 12203 Berlin, Germany; University Hospital Otto von Guericke University, Dept. of Urology, Leipziger Straße 44, 39120 Magdeburg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Baumunk
authors.affiliation: University Hospital Charité - Campus Mitte, Dept. of Urology, Chariteplatz 1, 10117 Berlin, Germany; Vivantes Humboldt-Clinic, Dept. of Urology, Am Nordgraben 2, 13509 Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Weikert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000209:etiology*; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology*; D011237:Predictive Value of Tests; D057216:Propensity Score; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Clavien–Dindo classification; Complications; Kidney cancer; Outcome; Surgery; Tumor thrombus