Impact of Preoperative Systemic Therapy on Cytoreductive Nephrectomy Outcomes in the National Surgical Quality...

Management of metastatic renal cell carcinoma (mRCC) is highly individualized and often involves cytoreductive nephrectomy (CN) and systemic therapy (ST). The optimal sequencing of CN and ST is uncertain. A difference in perioperative outcomes based on sequence of CN and ST could influence decisionmaking. We analyzed the National Surgical Quality Improvement Program (NSQIP) database to assess whether preoperative systemic therapy adversely impacted perioperative outcomes in patients receiving deferred CN.

This analysis was conducted using the American College of Surgeons NSQIP Participant Use Data File for years 2019 and 2020. Groups were stratified by their receipt of preoperative systemic therapy within 90 days before CN. The primary outcome of our study was overall major complication rate. Secondary outcomes included overall complication rate, length of stay, operative time, discharge to home, adjunctive procedures, conversion from minimally-invasive to open surgery and infectious complications. Multivariate logistic regression was used to assess the role of preoperative systemic therapy and other predictors on the primary and secondary outcome(s).

The study cohort comprised of 752 patients (586 upfront vs. 166 deferred) undergoing cytoreductive nephrectomy from 2019-2021. There were no significant differences in major complication rate (8% upfront vs. 5% deferred, P = .188) or overall complication rate (33% upfront vs. 39% deferred, P = .152). On multivariate analysis, bleeding diathesis, adjunctive procedures, and higher ASA class were predictive of major complications. Patients receiving preoperative ST were more likely to be on steroids (23% vs. 7%, p.