Complications and Outcomes Associated With Surgical Management of Renal Cell Carcinoma Involving the Liver: A Matched Cohort Study

Daniel D. Joyce, Sarah P. Psutka, Ryan T. Groeschl, R. Houston Thompson, Stephen A. Boorjian, John C. Cheville, Suzanne Merrill, Christine M. Lohse, Brian A. Costello, Florencia G. Que, Bradley C. Leibovich

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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. Materials and 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. Conclusion 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.

Original languageEnglish (US)
Pages (from-to)155-161
Number of pages7
JournalUrology
Volume99
DOIs
StatePublished - Jan 1 2017

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Renal Cell Carcinoma
Cohort Studies
Liver
Nephrectomy
Venous Thrombosis
Metastasectomy
Mortality
Safety
Survival

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Joyce, D. D., Psutka, S. P., Groeschl, R. T., Thompson, R. H., Boorjian, S. A., Cheville, J. C., ... Leibovich, B. C. (2017). Complications and Outcomes Associated With Surgical Management of Renal Cell Carcinoma Involving the Liver: A Matched Cohort Study. Urology, 99, 155-161. https://doi.org/10.1016/j.urology.2016.08.015
Joyce, Daniel D. ; Psutka, Sarah P. ; Groeschl, Ryan T. ; Thompson, R. Houston ; Boorjian, Stephen A. ; Cheville, John C. ; Merrill, Suzanne ; Lohse, Christine M. ; Costello, Brian A. ; Que, Florencia G. ; Leibovich, Bradley C. / Complications and Outcomes Associated With Surgical Management of Renal Cell Carcinoma Involving the Liver : A Matched Cohort Study. In: Urology. 2017 ; Vol. 99. pp. 155-161.
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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. Materials and 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. Conclusion 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.",
author = "Joyce, {Daniel D.} and Psutka, {Sarah P.} and Groeschl, {Ryan T.} and Thompson, {R. Houston} and Boorjian, {Stephen A.} and Cheville, {John C.} and Suzanne Merrill and Lohse, {Christine M.} and Costello, {Brian A.} and Que, {Florencia G.} and Leibovich, {Bradley C.}",
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Joyce, DD, Psutka, SP, Groeschl, RT, Thompson, RH, Boorjian, SA, Cheville, JC, Merrill, S, Lohse, CM, Costello, BA, Que, FG & Leibovich, BC 2017, 'Complications and Outcomes Associated With Surgical Management of Renal Cell Carcinoma Involving the Liver: A Matched Cohort Study', Urology, vol. 99, pp. 155-161. https://doi.org/10.1016/j.urology.2016.08.015

Complications and Outcomes Associated With Surgical Management of Renal Cell Carcinoma Involving the Liver : A Matched Cohort Study. / Joyce, Daniel D.; Psutka, Sarah P.; Groeschl, Ryan T.; Thompson, R. Houston; Boorjian, Stephen A.; Cheville, John C.; Merrill, Suzanne; Lohse, Christine M.; Costello, Brian A.; Que, Florencia G.; Leibovich, Bradley C.

In: Urology, Vol. 99, 01.01.2017, p. 155-161.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Complications and Outcomes Associated With Surgical Management of Renal Cell Carcinoma Involving the Liver

T2 - A Matched Cohort Study

AU - Joyce, Daniel D.

AU - Psutka, Sarah P.

AU - Groeschl, Ryan T.

AU - Thompson, R. Houston

AU - Boorjian, Stephen A.

AU - Cheville, John C.

AU - Merrill, Suzanne

AU - Lohse, Christine M.

AU - Costello, Brian A.

AU - Que, Florencia G.

AU - Leibovich, Bradley C.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Objective To assess the safety and utility of more aggressive surgical resection of renal cell carcinoma involving the liver at the time of nephrectomy. Materials and 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. Conclusion 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.

AB - Objective To assess the safety and utility of more aggressive surgical resection of renal cell carcinoma involving the liver at the time of nephrectomy. Materials and 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. Conclusion 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.

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DO - 10.1016/j.urology.2016.08.015

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