Introduction

Little is known about the impact of reduced left ventricular ejection fraction (rLVEF) on outcomes of patients undergoing surgery for renal cell carcinoma (RCC). The aim of our study was to compare complication rate, perioperative mortality, other-cause mortality (OCM) and overall mortality (OM) between cardiopathic patients (rLVEF) and matched controls.

Methods

Between 1990 and 2016, 2,974 consecutive patients treated with surgery for RCC were collected into an institutional database. When LVEF was <50% at preoperative transthoracic cardiac ultrasound, patients were classified as rLVEF, according to European Society of Cardiology Guidelines. Propensity-score matching was performed between patients with rLVEF and controls without rLVEF with a 1-to-4 ratio, after adjusting for age, body mass index, comorbidities (diabetes, hypertension and Charlson Comorbidity Index) and tumour characteristics (TNM classification).

Results

After matching 1:4, 175 patients (35 rLVEF vs. 140 controls) were included in the analyses. In the matched cohort, no differences were recorded in terms of baseline clinical features and tumor characteristics. Low grade complications (Clavien-Dindo I-II) were reported in 20% of controls vs. 41% of rLVEF patients (p<0.01). High grade complications (Clavien-Dindo III-IV) were reported in 4% vs. 2.5% (p=0.6) in the control vs. rLVEF groups, respectively. Thirty-day and 90-day mortality rates were 1.3% and 1.4% in the control group vs. 0% and 0% in rLVEF counterparts (all p=0.9). At 1, 5 and 10 years after surgery, OCM resulted 3.2%, 12.5% and 26% vs. 0%, 17.8% and 38.3% in controls vs. rLVEF (p=0.2). Correspondingly, at 1, 5 and 10 years after surgery, OM resulted 4.9%, 22.8% and 40.4% vs. 3.3%, 34.2% and 76.7% in controls vs. rLVEF (p=0.6).

Conclusions

After matching, patients with rLVEF experienced more frequently minor complications (Clavien-Dindo I-II) relative to controls. However, no differences in terms of high grade complications (Clavien-Dindo III-IV) and perioperative mortality were observed after surgery when patients with preoperative rLVEF were compared to equivalent non cardiopathic counterparts. When long-term survival outcomes were taken into consideration, no difference was recorded according to cardiopathic status.

Funding

None