Perioperative Morbidity Associated With Metastasectomy in Patients With Renal Cell Carcinoma

In this multicenter, retrospective study, 30-day morbidity of metastasectomy for mRCC was evaluated to identify features associated with postoperative complications using data from two international high-volume surgical centers. Adults treated with radical or partial nephrectomy for unilateral, sporadic RCC who underwent metastasectomy at Mayo Clinic Rochester or UZ Leuven between 2005 and 2020 were eligible for the study. This time frame was chosen to reflect a contemporary cohort encompassing the targeted therapy and immunotherapy (IO) eras. The primary outcome of a complication within 30 days of surgery was summarized in terms of percentages and 95% confidence intervals (CIs). Complications were classified according to Clavien–Dindo grade, with grades III–V considered major complications. A total of 740 metastasectomies among 522 patients were eligible for the study. Of the 522 patients, 372 underwent one, 102 underwent two, 30 underwent three, 16 underwent four, and two underwent five metastasectomies. Median overall survival was 5.5 years, and median cancer-specific survival was 6.0 years; median duration of follow-up among the 220 patients who were still alive at last follow-up was 5.4 years (IQR 2.7–9.3). Among the 740 operations, 193 (26%; 95% CI, 23–29) resulted in at least one 30-day postoperative complication, of which 161 (30%; 95% CI 26–34) were at the Mayo Clinic and 32 (16%; 95% CI, 12–22) were at UZ Leuven. There were 62 surgeries (8%; 95% CI, 7–11) with at least one major postoperative complication (Clavien–Dindo III–V), including 56 (10%; 95% CI, 8–13) at the Mayo Clinic and six (3%; 95% CI, 1–7) at UZ Leuven. Using the multivariable model examining 30-day postoperative complications, older age, higher BMI, higher ASA score, metastasectomy concurrent with nephrectomy, multiple anatomic sites of metastasis, pancreatic resection, and larger metastasis size were significantly associated with postoperative complications. None of the interactions between complete metastasectomy and the model variables were statistically significant, indicating that the associations can be applied to both incomplete and complete metastasectomy.

This study sought to present perioperative complications following metastasectomy for mRCC from an international multicenter cohort and notably observed a lower rate of perioperative complications following metastasectomy for mRCC than previously reported by other authors (rates of 26% for overall complications, 8% for major complications, and 1% for perioperative death within 30 days stand in notable contrast to rates of 45%–55% for overall and 27.5% for major complications from administrative data). Aside from providing risk factors for perioperative complications in this subset, this study is among the first to provide a comprehensive characterization of the perioperative morbidity of metastasectomy for mRCC using data from meticulously maintained disease registries, which show low rates of overall and major complications. Importantly, in a modern era of IO and TKI therapies, these data support relatively favorable perioperative outcomes that can be achieved with metastasectomy at high-volume centers and suggest that concerns over potential morbidity need not prohibit clinicians from offering metastasectomy to mRCC patients who are likely to benefit oncologically.