Perioperative Outcomes Following Surgical Resection of Renal Cell Carcinoma with Inferior Vena Cava Thrombus Extending Above the Hepatic Veins: A Contemporary Multicenter Experience
Perioperative Outcomes Following Surgical Resection of Renal Cell Carcinoma with Inferior Vena Cava Thrombus Extending Above the Hepatic Veins: A Contemporary Multicenter Experience
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DOI：
10.1016/j.eururo.2013.10.029
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发表时间：
2014-09-01
期刊：
影响因子：
23.4
通讯作者：
Wood, Christopher G.
中科院分区：
文献类型：
--
作者：
Abel, E. Jason;Thompson, R. Houston;Wood, Christopher G.
背景：肾细胞癌（RCC）患者肝静脉上方下腔静脉（IVC）血栓的手术治疗技术复杂，且与围手术期发病率和死亡率增加相关。然而，很少有资料描述当代主要转诊中心的围手术期结果或与不良结果相关的预后因素。目的：探讨肝静脉以上下腔静脉血栓肾癌患者术后主要并发症及术后90天死亡率的术前预测因素。设计、环境和参与者：我们回顾了2000年1月至2012年12月在梅奥诊所、m.d.安德森癌症中心、德克萨斯大学西南医学中心和威斯康星大学医院所有肝静脉上方有IVC肿瘤血栓并接受手术的RCC患者的医疗记录。结果测量及统计分析：根据Clavien- Dindo系统，术后90 d内记录的主要并发症定义为3A级。单因素和多因素分析用于评估术前变量与主要并发症风险或90天死亡率的关系。结果和局限性：共有162例患者被确定为研究对象（根据Neves分类，69,93例患者分别为3级和4级）。162例患者中60例（37.5%）行体外循环，40例（24.7%）术前行血管栓塞。55例（34.0%）患者报告了主要并发症，最常见的是呼吸、心脏和血液问题。经多因素分析，术前全身症状和4级血栓与主要并发症的风险增加独立相关。术后90 d内死亡17例（10.5%）。经多因素分析，东部肿瘤合作组（ECOG）的工作状态（PS）和低血清白蛋白是术前90天死亡率增加的独立因素。结论：有上水平血栓的RCC患者的围手术期死亡率和主要并发症发生率分别为10%和34%。ECOG PS bbb1或低血清白蛋白患者围手术期死亡风险增加。2013年欧洲泌尿外科协会。Elsevier b.v.版权所有。
Background: Surgery for renal cell carcinoma (RCC) patients with inferior vena cava (IVC) thrombus above the hepatic veins is technically complex and associated with an increased risk of perioperative morbidity and mortality. However, minimal data exist that describe contemporary perioperative outcomes at major referral centers or the prognostic factors associated with poor outcomes.Objective: To determine the preoperative predictors of major complications and 90- d mortality after surgery in RCC patients who have IVC thrombus above the hepatic veins.Design, setting, and participants: We reviewed medical records of all RCC patients who had IVC tumor thrombus above hepatic veins and had had surgery between January 2000 and December 2012 at the Mayo Clinic, M. D. Anderson Cancer Center, University of Texas Southwestern Medical Center, and the University of Wisconsin Hospital.Outcome measurement and statistical analysis: Major complications recorded were defined as 3A according to the Clavien- Dindo system within 90 d of surgery. Univariate and multivariate analyses were used to evaluate associations of preoperative variables with risk of major complications or 90- d mortality.Results and limitations: A total of 162 patients were identified for study (level 3, 4 in 69, 93 patients, respectively, according to the Neves classification). Cardiopulmonary bypass was used in 60 of 162 patients (37.5%), and 40 patients (24.7%) had preoperative angioembolization. Major complications were reported in 55 patients (34.0%), with the most common being respiratory, cardiac, and hematologic issues. After multivariate analysis, preoperative systemic symptoms and level 4 thrombus were independently associated with increased risk of major complications. Mortality was reported in 17 patients (10.5%) within 90 d after surgery. After multivariate analysis, Eastern Cooperative Oncology Group (ECOG) performance status (PS) and low serum albumin were preoperative factors independently associated with increased risk of 90- d mortality.Conclusions: Contemporary perioperative mortality and major complication rates for RCC patientswho have upper- level thrombus are 10% and 34%, respectively. Patientswho have ECOG PS > 1 or low serum albumin have increased risk for perioperative mortality. # 2013 European Association of Urology. Published by Elsevier B. V. All rights reserved.