title: Complications and Outcomes Associated With Surgical Management of Renal Cell Carcinoma Involving the Liver: A Matched Cohort Study.
abstract: OBJECTIVE
  To assess the safety and utility of more aggressive surgical resection of renal cell carcinoma involving the liver at the time of nephrectomy.
  
  
  METHODS
  We identified 34 cases at our institution where patients underwent simultaneous nephrectomy and hepatic resection for direct hepatic invasion (n = 17) or metastatic renal cell carcinoma (n = 21). Perioperative outcomes and complication rates were compared with a matched referent cohort (n = 68) undergoing simultaneous nephrectomy and resection of non-hepatic locally invasive or metastatic disease.
  
  
  RESULTS
  Of the 34 cases, 17 (50%) patients underwent hepatic resection for pT4 liver involvement and 21 (62%) patients underwent simultaneous nephrectomy and hepatic metastasectomy. Deep vein thrombosis occurred more frequently following hepatic resection (15% vs 1%, P = .02); however, no significant differences were noted in Clavien grade 3-4 complications (12% vs 3%, P = .10) or perioperative mortality (3% vs 0%, P = .67). Two-year cancer-specific and overall survival for patients undergoing hepatic resection and non-hepatic resection were 40% and 29% (hazard ratio: 0.72, P = .2) and 40% and 28% (hazard ratio: 0.80, P = .30), respectively.
  
  
  CONCLUSIONS
  In carefully selected patients, hepatic resection at the time of nephrectomy is associated with a higher risk of deep vein thrombosis and may be associated with a trend toward an increased risk of short-term Clavien IV complications; however, perioperative and overall mortality are comparable with those in matched patients undergoing surgical resection of locally advanced or metastatic disease involving non-hepatic organs.
authors.affiliation: Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Joyce
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN; Division of Urology, Department of Surgery, Cook County Hospital, Chicago, IL.
authors.forename: Sarah P
authors.initials: SP
authors.lastname: Psutka
authors.affiliation: Department of General Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Groeschl
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: R Houston
authors.initials: RH
authors.lastname: Thompson
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
authors.forename: John C
authors.initials: JC
authors.lastname: Cheville
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN.
authors.forename: Suzanne B
authors.initials: SB
authors.lastname: Stewart-Merrill
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.affiliation: Department of Oncology, Mayo Clinic, Rochester, MN.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Costello
authors.affiliation: Department of General Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Florencia G
authors.initials: FG
authors.lastname: Que
authors.affiliation: Department of Urology, Mayo Clinic, Rochester, MN. Electronic address: Leibovich.Bradley@mayo.edu.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Leibovich
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology