Association of an organ transplant-based approach with a dramatic reduction in postoperative complications following radical nephrectomy and tumor thrombectomy in renal cell carcinoma

Javier González, Jeffrey J. Gaynor, Juan I. Martínez-Salamanca, Umberto Capitanio, Derya Tilki, Joaquín A. Carballido, Venancio Chantada, Siamak Daneshmand, Christopher P. Evans, Claudia Gasch, Paolo Gontero, Axel Haferkamp, William C. Huang, Estefania Linares Espinós, Viraj A. Master, James M. McKiernan, Francesco Montorsi, Sascha Pahernik, Juan Palou, Raj S. PruthiOscar Rodriguez-Faba, Paul Russo, Douglas S. Scherr, Shahrokh F. Shariat, Martin Spahn, Carlo Terrone, Cesar Vera-Donoso, Richard Zigeuner, Markus Hohenfellner, John A. Libertino, Gaetano Ciancio

Research output: Contribution to journalArticle

Abstract

Objectives: Our aim was to determine whether using an organ transplant-based(TB) approach reduces postoperative complications(PCs) following radical nephrectomy(RN) and tumor thrombectomy(TT) in renal cell carcinoma(RCC) patients with level II-IV thrombi. Methods: A total of 390(292 non-TB/98 TB) IRCC-VT Consortium patients who received no preoperative embolization/IVC filter were included. Stepwise linear/logistic regression analyses were performed to determine significant multivariable predictors of intraoperative estimated blood loss(IEBL), number blood transfusions received, and overall/major PC development within 30days following surgery. Propensity to receive the TB approach was controlled. Results: The TB approach was clearly superior in limiting IEBL, blood transfusions, and PC development, even after controlling for other significant prognosticators/propensity score(P < .000001 in each case). Median IEBL for non-TB/TB approaches was 1000 cc/300 cc and 1500 cc/500 cc for tumor thrombus Level II-III patients, respectively, with no notable differences for Level IV patients(2000 cc each). In comparing PC outcomes between non-TB/TB patients with a non-Right-Atrium Cranial Limit, the observed percentage developing a: i) PC was 65.8%(133/202) vs. 4.3%(3/69) for ECOG Performance Status(ECOG-PS) 0–1, and 84.8%(28/33) vs. 25.0%(4/16) for ECOG-PS 2–4, and ii) major PC was 16.8%(34/202) vs. 1.4%(1/69) for ECOG-PS 0–1, and 27.3%(9/33) vs. 12.5%(2/16) for ECOG-PS 2–4. Major study limitation was the fact that all TB patients were treated by a single, experienced, high volume surgeon from one center (non-TB patients were treated by various surgeons at 13 other centers). Conclusions: Despite this major study limitation, the observed dramatic differences in PC outcomes suggest that the TB approach offers a major breakthrough in limiting operative morbidity in RCC patients receiving RN and TT.

Original languageEnglish (US)
JournalEuropean Journal of Surgical Oncology
DOIs
StateAccepted/In press - Jan 1 2019

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Thrombectomy
Nephrectomy
Renal Cell Carcinoma
Transplants
Neoplasms
Blood Transfusion
Thrombosis
Propensity Score
Linear Models
Logistic Models
Regression Analysis
Morbidity

Keywords

  • Inferior vena cava
  • Postoperative complications
  • Renal cell carcinoma
  • Surgical technique
  • Tumor thrombus

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Association of an organ transplant-based approach with a dramatic reduction in postoperative complications following radical nephrectomy and tumor thrombectomy in renal cell carcinoma. / González, Javier; Gaynor, Jeffrey J.; Martínez-Salamanca, Juan I.; Capitanio, Umberto; Tilki, Derya; Carballido, Joaquín A.; Chantada, Venancio; Daneshmand, Siamak; Evans, Christopher P.; Gasch, Claudia; Gontero, Paolo; Haferkamp, Axel; Huang, William C.; Espinós, Estefania Linares; Master, Viraj A.; McKiernan, James M.; Montorsi, Francesco; Pahernik, Sascha; Palou, Juan; Pruthi, Raj S.; Rodriguez-Faba, Oscar; Russo, Paul; Scherr, Douglas S.; Shariat, Shahrokh F.; Spahn, Martin; Terrone, Carlo; Vera-Donoso, Cesar; Zigeuner, Richard; Hohenfellner, Markus; Libertino, John A.; Ciancio, Gaetano.

In: European Journal of Surgical Oncology, 01.01.2019.

Research output: Contribution to journalArticle

González, J, Gaynor, JJ, Martínez-Salamanca, JI, Capitanio, U, Tilki, D, Carballido, JA, Chantada, V, Daneshmand, S, Evans, CP, Gasch, C, Gontero, P, Haferkamp, A, Huang, WC, Espinós, EL, Master, VA, McKiernan, JM, Montorsi, F, Pahernik, S, Palou, J, Pruthi, RS, Rodriguez-Faba, O, Russo, P, Scherr, DS, Shariat, SF, Spahn, M, Terrone, C, Vera-Donoso, C, Zigeuner, R, Hohenfellner, M, Libertino, JA & Ciancio, G 2019, 'Association of an organ transplant-based approach with a dramatic reduction in postoperative complications following radical nephrectomy and tumor thrombectomy in renal cell carcinoma', European Journal of Surgical Oncology. https://doi.org/10.1016/j.ejso.2019.05.009
González, Javier ; Gaynor, Jeffrey J. ; Martínez-Salamanca, Juan I. ; Capitanio, Umberto ; Tilki, Derya ; Carballido, Joaquín A. ; Chantada, Venancio ; Daneshmand, Siamak ; Evans, Christopher P. ; Gasch, Claudia ; Gontero, Paolo ; Haferkamp, Axel ; Huang, William C. ; Espinós, Estefania Linares ; Master, Viraj A. ; McKiernan, James M. ; Montorsi, Francesco ; Pahernik, Sascha ; Palou, Juan ; Pruthi, Raj S. ; Rodriguez-Faba, Oscar ; Russo, Paul ; Scherr, Douglas S. ; Shariat, Shahrokh F. ; Spahn, Martin ; Terrone, Carlo ; Vera-Donoso, Cesar ; Zigeuner, Richard ; Hohenfellner, Markus ; Libertino, John A. ; Ciancio, Gaetano. / Association of an organ transplant-based approach with a dramatic reduction in postoperative complications following radical nephrectomy and tumor thrombectomy in renal cell carcinoma. In: European Journal of Surgical Oncology. 2019.
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abstract = "Objectives: Our aim was to determine whether using an organ transplant-based(TB) approach reduces postoperative complications(PCs) following radical nephrectomy(RN) and tumor thrombectomy(TT) in renal cell carcinoma(RCC) patients with level II-IV thrombi. Methods: A total of 390(292 non-TB/98 TB) IRCC-VT Consortium patients who received no preoperative embolization/IVC filter were included. Stepwise linear/logistic regression analyses were performed to determine significant multivariable predictors of intraoperative estimated blood loss(IEBL), number blood transfusions received, and overall/major PC development within 30days following surgery. Propensity to receive the TB approach was controlled. Results: The TB approach was clearly superior in limiting IEBL, blood transfusions, and PC development, even after controlling for other significant prognosticators/propensity score(P < .000001 in each case). Median IEBL for non-TB/TB approaches was 1000 cc/300 cc and 1500 cc/500 cc for tumor thrombus Level II-III patients, respectively, with no notable differences for Level IV patients(2000 cc each). In comparing PC outcomes between non-TB/TB patients with a non-Right-Atrium Cranial Limit, the observed percentage developing a: i) PC was 65.8{\%}(133/202) vs. 4.3{\%}(3/69) for ECOG Performance Status(ECOG-PS) 0–1, and 84.8{\%}(28/33) vs. 25.0{\%}(4/16) for ECOG-PS 2–4, and ii) major PC was 16.8{\%}(34/202) vs. 1.4{\%}(1/69) for ECOG-PS 0–1, and 27.3{\%}(9/33) vs. 12.5{\%}(2/16) for ECOG-PS 2–4. Major study limitation was the fact that all TB patients were treated by a single, experienced, high volume surgeon from one center (non-TB patients were treated by various surgeons at 13 other centers). Conclusions: Despite this major study limitation, the observed dramatic differences in PC outcomes suggest that the TB approach offers a major breakthrough in limiting operative morbidity in RCC patients receiving RN and TT.",
keywords = "Inferior vena cava, Postoperative complications, Renal cell carcinoma, Surgical technique, Tumor thrombus",
author = "Javier Gonz{\'a}lez and Gaynor, {Jeffrey J.} and Mart{\'i}nez-Salamanca, {Juan I.} and Umberto Capitanio and Derya Tilki and Carballido, {Joaqu{\'i}n A.} and Venancio Chantada and Siamak Daneshmand and Evans, {Christopher P.} and Claudia Gasch and Paolo Gontero and Axel Haferkamp and Huang, {William C.} and Espin{\'o}s, {Estefania Linares} and Master, {Viraj A.} and McKiernan, {James M.} and Francesco Montorsi and Sascha Pahernik and Juan Palou and Pruthi, {Raj S.} and Oscar Rodriguez-Faba and Paul Russo and Scherr, {Douglas S.} and Shariat, {Shahrokh F.} and Martin Spahn and Carlo Terrone and Cesar Vera-Donoso and Richard Zigeuner and Markus Hohenfellner and Libertino, {John A.} and Gaetano Ciancio",
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doi = "10.1016/j.ejso.2019.05.009",
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TY - JOUR

T1 - Association of an organ transplant-based approach with a dramatic reduction in postoperative complications following radical nephrectomy and tumor thrombectomy in renal cell carcinoma

AU - González, Javier

AU - Gaynor, Jeffrey J.

AU - Martínez-Salamanca, Juan I.

AU - Capitanio, Umberto

AU - Tilki, Derya

AU - Carballido, Joaquín A.

AU - Chantada, Venancio

AU - Daneshmand, Siamak

AU - Evans, Christopher P.

AU - Gasch, Claudia

AU - Gontero, Paolo

AU - Haferkamp, Axel

AU - Huang, William C.

AU - Espinós, Estefania Linares

AU - Master, Viraj A.

AU - McKiernan, James M.

AU - Montorsi, Francesco

AU - Pahernik, Sascha

AU - Palou, Juan

AU - Pruthi, Raj S.

AU - Rodriguez-Faba, Oscar

AU - Russo, Paul

AU - Scherr, Douglas S.

AU - Shariat, Shahrokh F.

AU - Spahn, Martin

AU - Terrone, Carlo

AU - Vera-Donoso, Cesar

AU - Zigeuner, Richard

AU - Hohenfellner, Markus

AU - Libertino, John A.

AU - Ciancio, Gaetano

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: Our aim was to determine whether using an organ transplant-based(TB) approach reduces postoperative complications(PCs) following radical nephrectomy(RN) and tumor thrombectomy(TT) in renal cell carcinoma(RCC) patients with level II-IV thrombi. Methods: A total of 390(292 non-TB/98 TB) IRCC-VT Consortium patients who received no preoperative embolization/IVC filter were included. Stepwise linear/logistic regression analyses were performed to determine significant multivariable predictors of intraoperative estimated blood loss(IEBL), number blood transfusions received, and overall/major PC development within 30days following surgery. Propensity to receive the TB approach was controlled. Results: The TB approach was clearly superior in limiting IEBL, blood transfusions, and PC development, even after controlling for other significant prognosticators/propensity score(P < .000001 in each case). Median IEBL for non-TB/TB approaches was 1000 cc/300 cc and 1500 cc/500 cc for tumor thrombus Level II-III patients, respectively, with no notable differences for Level IV patients(2000 cc each). In comparing PC outcomes between non-TB/TB patients with a non-Right-Atrium Cranial Limit, the observed percentage developing a: i) PC was 65.8%(133/202) vs. 4.3%(3/69) for ECOG Performance Status(ECOG-PS) 0–1, and 84.8%(28/33) vs. 25.0%(4/16) for ECOG-PS 2–4, and ii) major PC was 16.8%(34/202) vs. 1.4%(1/69) for ECOG-PS 0–1, and 27.3%(9/33) vs. 12.5%(2/16) for ECOG-PS 2–4. Major study limitation was the fact that all TB patients were treated by a single, experienced, high volume surgeon from one center (non-TB patients were treated by various surgeons at 13 other centers). Conclusions: Despite this major study limitation, the observed dramatic differences in PC outcomes suggest that the TB approach offers a major breakthrough in limiting operative morbidity in RCC patients receiving RN and TT.

AB - Objectives: Our aim was to determine whether using an organ transplant-based(TB) approach reduces postoperative complications(PCs) following radical nephrectomy(RN) and tumor thrombectomy(TT) in renal cell carcinoma(RCC) patients with level II-IV thrombi. Methods: A total of 390(292 non-TB/98 TB) IRCC-VT Consortium patients who received no preoperative embolization/IVC filter were included. Stepwise linear/logistic regression analyses were performed to determine significant multivariable predictors of intraoperative estimated blood loss(IEBL), number blood transfusions received, and overall/major PC development within 30days following surgery. Propensity to receive the TB approach was controlled. Results: The TB approach was clearly superior in limiting IEBL, blood transfusions, and PC development, even after controlling for other significant prognosticators/propensity score(P < .000001 in each case). Median IEBL for non-TB/TB approaches was 1000 cc/300 cc and 1500 cc/500 cc for tumor thrombus Level II-III patients, respectively, with no notable differences for Level IV patients(2000 cc each). In comparing PC outcomes between non-TB/TB patients with a non-Right-Atrium Cranial Limit, the observed percentage developing a: i) PC was 65.8%(133/202) vs. 4.3%(3/69) for ECOG Performance Status(ECOG-PS) 0–1, and 84.8%(28/33) vs. 25.0%(4/16) for ECOG-PS 2–4, and ii) major PC was 16.8%(34/202) vs. 1.4%(1/69) for ECOG-PS 0–1, and 27.3%(9/33) vs. 12.5%(2/16) for ECOG-PS 2–4. Major study limitation was the fact that all TB patients were treated by a single, experienced, high volume surgeon from one center (non-TB patients were treated by various surgeons at 13 other centers). Conclusions: Despite this major study limitation, the observed dramatic differences in PC outcomes suggest that the TB approach offers a major breakthrough in limiting operative morbidity in RCC patients receiving RN and TT.

KW - Inferior vena cava

KW - Postoperative complications

KW - Renal cell carcinoma

KW - Surgical technique

KW - Tumor thrombus

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