title: Nephrectomy and inferior vena cava thrombectomy for renal cell carcinoma among patients with impaired renal function: defining predictors of outcomes.
abstract: BACKGROUND
  Management of renal cell carcinoma (RCC) with inferior vena cava thrombus (IVCT) is associated with high morbidity. Chronic kidney disease (CKD) is a known risk factor for perioperative complications in many surgical procedures. The objective of this study was to review the association between preoperative CKD (eGFR < 60 mL/min) and post-operative outcomes in patients with RCC and IVCT undergoing radical nephrectomy (RN) and tumour thrombectomy (TT).
  
  
  METHODS
  A retrospective review of patients with RCC and IVCT treated with RN and TT was carried out. Complications were recorded according to the Clavien-Dindo classification. Multivariable models were fitted using logistic regression analyses for high-grade complications and salvage therapies and linear-regression for intraoperative blood loss (IBL).
  
  
  RESULTS
  One hundred and one patients with RCC and IVCT, treated with RN and TT, were identified. Forty per cent of patients had preoperative CKD. Median IBL was higher in CKD arm (2.5 versus 1.6 L, P = 0.04). In a multivariate linear regression analysis, CKD (beta 1.34, P = 0.01) remained an independent predictor of IBL. High-grade complications were more frequent in the CKD group (34% versus 16%, P = 0.09) and in logistic regression analysis, CKD was an independent predictor of high-grade complications (OR 3.33, 95% CI 1.01-10.9). Furthermore, CKD patients were less likely to be considered for salvage therapies (62% versus 38%, P = 0.02).
  
  
  CONCLUSIONS
  In patients treated with RN and TT, CKD is an independent predictor of perioperative morbidity. This clinical variable should be considered when selecting patients and subsequent efforts should be made to optimize other competing risk factors in order to reduce the incidence of perioperative adverse events in this patient population.
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Kamran
authors.initials: K
authors.lastname: Zargar-Shoshtari
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Kenan
authors.initials: K
authors.lastname: Ashouri
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Pranav
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Baumgarten
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Wade J
authors.initials: WJ
authors.lastname: Sexton
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Julio
authors.initials: J
authors.lastname: Pow-Sang
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D051437:Renal Insufficiency / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D016019:Survival Analysis; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*
keywords: complication; inferior vena cava; renal cell carcinoma; thrombectomy