Surgical outcomes of cytoreductive nephrectomy in patients receiving systemic immunotherapy for advanced renal cell carcinoma Journal Article
| Authors: | Reese, S. W.; Eismann, L.; White, C.; Arroyave Villada, J.; Khaleel, S.; Ostrovnaya, I.; Vazquez-Rivera, K.; Carlo, M. I.; Feldman, D.; Lee, C. H.; Motzer, R.; Voss, M. H.; Kotecha, R. R.; Matulewicz, R. S.; Goh, A.; Coleman, J.; Russo, P.; Hakimi, A. A. |
| Article Title: | Surgical outcomes of cytoreductive nephrectomy in patients receiving systemic immunotherapy for advanced renal cell carcinoma |
| Abstract: | Purpose: The use of systemic immune checkpoint blockade before surgery is increasing in patients with metastatic renal cell carcinoma, however, the safety and feasibility of performing consolidative cytoreductive nephrectomy after the administration of systemic therapy are not well described. Patients and Methods: A retrospective review of patients undergoing nephrectomy was performed using our prospectively maintained institutional database. Patients who received preoperative systemic immunotherapy were identified, and the risk of postoperative complications were compared to those who underwent surgery without upfront systemic treatment. Perioperative characteristics and surgical complications within 90 days following surgery were recorded. Results: Overall, we identified 220 patients who underwent cytoreductive nephrectomy from April 2015 to December 2022, of which 46 patients (21%) received systemic therapy before undergoing surgery. Unadjusted rates of surgical complications included 20% (n = 35) in patients who did not receive upfront systemic therapy and 20% (n = 9) in those who received upfront systemic immunotherapy. In our propensity score analysis, there was no statistically significant association between receipt of upfront immunotherapy and 90-day surgical complications [odds ratio (OR): 1.82, 95% confidence interval (CI): 0.59–5.14; P = 0.3]. This model, however, demonstrated an association between receipt of upfront immunotherapy and an increased odds of requiring a blood transfusion [OR: 4.53, 95% CI: 1.83–11.7; P = 0.001]. Conclusion: In our cohort, there was no significant difference in surgical complications among patients who received systemic therapy before surgery compared to those who did not receive upfront systemic therapy. Cytoreductive nephrectomy is safe and with low rates of complications following the use of systemic therapy. © 2023 Elsevier Inc. |
| Keywords: | adult; controlled study; aged; middle aged; major clinical study; advanced cancer; systemic therapy; treatment duration; neoadjuvant therapy; cancer staging; prospective study; cytoreductive surgery; cancer immunotherapy; anemia; cohort analysis; hemoglobin; deep vein thrombosis; hemoglobin blood level; kidney failure; medical record review; retrospective study; risk factor; renal cell carcinoma; nephrectomy; pneumonia; lung embolism; postoperative complication; acute kidney failure; hyponatremia; length of stay; immunotherapy; operation duration; surgical infection; comorbidity; blood transfusion; ambulatory care; surgery; postoperative infection; minimally invasive surgery; pleura effusion; emergency care; perioperative period; intestine perforation; preoperative treatment; hospital readmission; kidney cancer; drug therapy; hematoma; therapy; resuscitation; heart arrest; chylous ascites; small intestine obstruction; respiratory failure; metastatic renal cell carcinoma; complication; peroperative complication; clinical outcome; septic shock; spleen injury; cytoreductive nephrectomy; enterocutaneous fistula; chylothorax; propensity score; abdominal infection; open surgery; immune checkpoint inhibitor; digestive system injury; postoperative ileus; charlson comorbidity index; operative blood loss; human; male; female; article; hemorrhagic shock; immune checkpoint inhibitors |
| Journal Title: | Urologic Oncology: Seminars and Original Investigations |
| Volume: | 42 |
| Issue: | 2 |
| ISSN: | 1078-1439 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2024-02-01 |
| Start Page: | 32.e9 |
| End Page: | 32.e16 |
| Language: | English |
| DOI: | 10.1016/j.urolonc.2023.12.003 |
| PUBMED: | 38135627 |
| PROVIDER: | scopus |
| PMCID: | PMC10922785 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF. Corresponding MSK author is A. Ari Hakimi -- Source: Scopus |
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