Surgical harm of cytoreductive nephrectomy in the era of targeted therapy

In the September issue of Urology, Wallis et al. (1) examine the effect of disseminated cancer on perioperative outcomes in renal cell carcinoma (RCC) patients following radical nephrectomy. They utilized the National Surgical Quality Improvement Program (NSQIP), which is an American College of Surgeons initiative that supports the collection of risk-adjusted perioperative data to facilitate the assessment of surgical outcomes and complications in (within) 30 days of surgery. In contrast to previous studies that reported outcomes after cytoreductive nephrectomy, the strength of this study lies in the presence of a comparator group to merely assess the effect of “disseminated disease”. Wallis and colleagues therefore stratified the total of 7,800 NCC patients according to “disseminated” (8.4%) or “non-disseminated cancer” (91.6%) status. By relying on robust methodology the authors demonstrate a greater risk of major complications including mortality and reoperation [adjusted odds ratio (aOR) 2.04, 95% confidence interval (CI): 1.46–2.86), prolonged length of hospital stay (aOR 1.27, 95% CI: 1.06–1.53) and pulmonary (aOR 1.68, 95% CI: 1.09–2.59), venous thromboembolic (aOR 1.72, 95% CI: 1.01–2.96), as well as bleeding complications (aOR 2.12, 95% CI: 1.73–2.60) in the presence of disseminated cancer compared to non-disseminated status.