EURURO Vol. 72 No. 2

Platinum Priority – Brief Correspondence

Editorial by Andrea Minervini , Riccardo Campi, Alberto Lapini and Marco Carini on pp. 175–176 of this issue

Complications After Metastasectomy for Renal Cell

Carcinoma—A Population-based Assessment

Christian P. Meyer

a , b , 1 ,

Maxine Sun

a , 1 ,

Jose A. Karam

c ,

Jeffrey J. Leow

a ,

Guillermo de Velasco

d , e ,

Sumanta K. Pal

f ,

Steven L. Chang

a ,

Quoc-Dien Trinh

a ,

Toni K. Choueiri

d , *

Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA;

Department of Urology,

University Medical Center Hamburg—Eppendorf, Hamburg, Germany;

Department of Urology, The University of Texas MD Anderson Cancer Center,

Houston, Texas, USA;

Department of Medical Oncology, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA;

Department of Medical Oncology, University Hospital 12 de Octubre, Madrid, Spain;

Department of Medical Oncology & Therapeutics Research, City of

Hope, Duarte, California, USA

Patients withmetastatic renal cell carcinoma (mRCC) can be

treated with medical, ablative, or surgical therapy. Surgical

management of metastases may be offered with curative

intent in selected patients. Most studies to date on

metastasectomies in mRCC focused on cancer control. In

contrast, perioperative morbidity in patients treated with

metastasectomy has scarcely been evaluated

[1] .

Therefore,

we sought to comprehensively assess in-hospital complica-

tions following metastasectomy for mRCC patients treated

in the pre-targeted and targeted therapy era.

Using the National Inpatient Sample, patients with a

primary diagnosis of mRCC between 2000 and 2011 were

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Article info

Article history:

Accepted March 2, 2017

Associate Editor:

Giacomo Novara

Keywords:

Metastasectomy

Renal cell carcinoma

Complication

Clavien–Dindo

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Abstract

Metastasectomy has long been considered a valid treatment option for patients with

oligometastatic renal cell carcinoma (oligo-mRCC). However, the literature on compli-

cations in this setting is scarce. Our objective was to describe in-hospital complications

after metastasectomy in a contemporary cohort of patients with mRCC. Using the

National Inpatient Sample database (2000–2011), 45 279mRCC patients were identified.

Of those, 1102 underwent metastasectomies. The metastatic sites were the lungs, bone,

liver, lymph nodes, adrenal glands, and brain in, respectively, 52%, 29%, 19%, 14%, 11%,

and 3.4% of patients. The overall complication rate was 45.7%. Major complications

(Clavien III–V) constituted 27.5%. Resections of hepatic lesions were significantly

associated with higher odds of overall complications compared with any other site

(odds ratio 2.59, 95% confidence interval 1.84–3.62,

0.001). While metastasectomy

remains a potential treatment option in RCC with oligometastatic disease, the associated

complication rates are non-negligible; therefore, careful patient selection is warranted.

Patient summary:

We studied outcomes of patients with metastatic kidney cancer

treated with metastasectomy. While metastasectomy is a treatment option for meta-

static renal cell carcinoma, complications are not insignificant and our results may guide

preoperative counseling.

These authors contributed equally.

* Corresponding author. Department of Medical Oncology, Lank Center for Genitourinary Oncology,

Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA. Tel. +1 617 632 5456;

Fax: +1 617 632 2165.

E-mail address:

Toni_Choueiri@DFCI.HARVARD.EDU

(T.K. Choueiri).

http://dx.doi.org/10.1016/j.eururo.2017.03.005

0302-2838/