Introduction

Radical nephroureterectomy (RNU) is the gold standard for management of bulky, invasive, or high grade upper-tract urothelial carcinoma (UTUC). Patients undergoing RNU are elderly and comorbid therefore placing them at risk for complications following surgery. We review an international multi-center cohort of RNU patients to identify the incidence of major complications and risk factors for their occurrence.

Methods

The charts of 1266 patients undergoing RNU at 14 international academic medical centers between 2002 and 2015 were reviewed. Preoperative clinical, demographic, and comorbidity indices were collected. Complications occurring within 30 days of surgery were graded using the modified Clavien-Dindo scale. Multivariate logistic regression determined the association between preoperative variables and Clavien III or greater post-RNU complications.

Results

A total of 707 men and 559 women with a median age of 70 years and body mass index of 27 kg/m2 were included. Almost 80% of the cohort was white, 17% had an Eastern Cooperative Oncology Group (ECOG) performance status ≥ 2, 22% had a Charlson comorbidity index (CCI) score > 5 and 50% had baseline chronic disease (CKD) ≥ stage III. Overall, 413 (33%) experienced a complication including 103 (8.1%) with a Clavien grade ≥ III. Specific distribution of major complications included 49 Clavien III, 44 Clavien IV, and 10 Clavien V. On univariate analysis, patient age (p=0.006), ASA score (p=0.02), ECOG (p<0.0001), CCI (p<0.0001), HTN (p=0.002), DM (p=0.02), and CKD stage (p<0.001) all were associated with major complications. A multivariate linear regression model highlighted that ECOG ≥ 2 (OR 2.38, p=0.001), CCI > 5 (OR 3.44, p=0.007), and CKD stage ≥ 3 (OR 3.64, p=0.008) were independently associated with major complications. (Table)

Conclusions

Major complications occur in 8% of patients undergoing RNU. Impaired preoperative performance status (as determined by ECOG or Charlson comorbidity index) and baseline CKD are associated with a major post-surgical adverse event. These easily measurable indices warrant consideration prior to proceeding with RNU.

Funding

None