Operative mortality after nephrectomy for renal cell carcinoma

• Published in: Scandinavian Journal of Urology and Nephrology
• Main Authors: Thoroddsen, Asgeir, Gudbjartsson, Tomas, Jonsson, Eirikur, Gislason, Thorsteinn, Einarsson, Gudmundur Vikar
• Format: Article in Journal/Newspaper
• Language: English
• Published: Taylor & Francis 2003
• Subjects: Survival Rate; Statistics; Nonparametric; Sex Distribution; Risk Assessment; Research Support; Non-U.S. Gov't; Probability; Nephrectomy; Neoplasm Staging; Middle Aged; Male; Kidney Neoplasms; Iceland; Hospital Mortality; Carcinoma; Renal Cell; Age Distribution
• Online Access: http://hdl.handle.net/2336/4641; https://doi.org/10.1080/00365590310015732

To access publisher full text version of this article. Please click on the hyperlink in Additional Links field OBJECTIVE: To study the rate and causes of operative and treatment-related mortality after nephrectomy for renal cell carcinoma (RCC) in Iceland. MATERIAL AND METHODS: This retrospective population-based study included all patients who underwent nephrectomy for RCC in Iceland between 1971 and 2000. Patients who died <30 days after the operation were analyzed and compared to those who survived surgery. Disease stage, tumor size, patient age and preoperative American Society of Anesthesiologists classification were compared between the two groups. Autopsy records were examined to determine the causes of death. RESULTS: During the study period 880 patients were diagnosed with RCC and 575 (65%) of them underwent a nephrectomy, 116 (20%) with palliative intent. Operative mortality (OM) was 2.8% and did not change during the 30-year period. Patients with OM were significantly older than those without (73 vs 64 years, respectively) but disease stage, tumor size, ASA classification and gender were comparable between the groups. OM was comparable for patients operated on with palliative (3.4%) vs. curative (2.6%) intent (ns). Median time of death was 10 days postoperatively but no patient died intraoperatively. Causes of death were peri- and postoperative bleeding in five patients, infection/sepsis in four, arrhythmia in three, acute renal failure in two, pulmonary embolism in one and multiorgan failure in one. CONCLUSIONS: OM after nephrectomy for RCC has remained low during the past three decades in Iceland. It is most often caused by perioperative bleeding and infections. We find that the low OM in patients with metastases gives support to the use of palliative nephrectomy as a treatment option when other forms of treatment have failed.