Incidence and preoperative predictors for major complications following radical nephroureterectomy

Neil J. Kocher, David Canes, Karim Bensalah, Morgan Roupret, Costas Lallas, Vitaly Margulis, Shahrokh Shariat, Pierre Colin, Surena Matin, Chad Tracy, Evanguelos Xylinas, Andrew Wagner, Mathieu Roumiguie, Wassim Kassouf, Tobias Klatte, Jay D. Raman

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Radical nephroureterectomy (RNU) is the referent standard for managing bulky, invasive, or high grade upper-tract urothelial carcinoma (UTUC). The UTUC patient population, however, generally harbor medical comorbidities thereby placing them at risk of surgical complications. This study reviews a large international cohort of RNU patients to define the risk of major complications and preoperative factors associated with their occurrence. Methods: Patients undergoing RNU at 14 academic medical centers between 2002 and 2015 were retrospectively reviewed. Preoperative clinical, demographic, operative, and comorbidity indices were recorded. The modified Clavien-Dindo index was used to grade complications occurring within 30 days of surgery. The association between preoperative variables and major complications occurring after RNU was determined by multivariable logistic regression. Results: One thousand two hundred and sixty-six patients (707 men; 559 women) with a median age of 70 years and BMI of 27 kg/m2 were included. Over three-quarters of the cohort was white, 50.1% had baseline chronic kidney disease (CKD) ≥ stage III, 22.4% had a Charlson comorbidity index (CCI) score >5, and 17.1% had an Eastern Cooperative Oncology Group (ECOG) performance status ≥2. Overall, 413 (32.6%) experienced a complication including 103 (8.1%) with a major event. Specific distribution of major complications included 49 Clavien III, 44 Clavien IV, and 10 Clavien V. On univariate analysis, patient age (P=0.006), hypertension (P=0.002), diabetes mellitus (P=0.023), CKD stage (P<0.001), American Society of Anesthesiologists (ASA) score (P=0.022), ECOG (P<0.001), and CCI (P<0.001) all were associated with major complications. On multivariate analysis, ECOG ≥2 (OR 2.38, 95% CI, 1.46-3.90), P=0.001), CCI >5 (OR 3.45, 95% CI, 1.41-8.33, P=0.007), and CKD stage ≥3 (OR 3.64, P=0.008) were independently associated with major complications. Conclusions: Major complications following RNU occurred in almost 10% of patients. Impaired preoperative performance status and baseline CKD are preoperative variables associated with these major post-surgical adverse event. These easily measurable indices warrant consideration and discussion prior to proceeding with RNU.

Original languageEnglish (US)
Pages (from-to)1786-1793
Number of pages8
JournalTranslational Andrology and Urology
Volume9
Issue number4
DOIs
StatePublished - Aug 1 2020

Keywords

  • Chronic kidney disease (ckd)
  • Major complications
  • Performance status
  • Radical nephroureterectomy (rnu)
  • Upper tract urothelial carcinoma (utuc)

ASJC Scopus subject areas

  • Reproductive Medicine
  • Urology

Fingerprint Dive into the research topics of 'Incidence and preoperative predictors for major complications following radical nephroureterectomy'. Together they form a unique fingerprint.

Cite this