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

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• 作者：Daniel D. Joyce^a ; Sarah P. Psutka^b ; ^c ; Ryan T. Groeschl^d ; R. Houston Thompson^b ; Stephen A. Boorjian^b ; John C. Cheville^e ; Suzanne B. Stewart-Merrill^b ; Christine M. Lohse^f ; Brian A. Costello^g ; Florencia G. Que^d ; Bradley C. Leibovich^b ; ^{Leibovich.Bradley@mayo.edu}
• 刊名：Urology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：99
• 期：Complete
• 页码：155-161
• 全文大小：636 K
• 卷排序：99

文摘

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 MethodsWe 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.ResultsOf 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.ConclusionIn 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.