Clinical, Operative Outcomes for Consolidative Nephrectomy After Systemic Immunotherapy

A propensity matched analysis compared the surgical outcomes of patients receiving consolidative nephrectomy after systemic immunotherapy with those who received upfront cytoreductive surgery.

Results of the analysis were presented at the American Urological Association 2023 Annual Meeting.

Further research is needed to improve the clinical and operative outcomes of patients undergoing consolidative nephrectomy after systemic immunotherapy.

Stephen W. Reese, MD, and colleagues conducted a single-institution study from a large academic center that retrospectively analyzed a cohort of patients undergoing surgery for metastatic kidney cancer from 2015 to 2022. Researchers used propensity score matching to match patients who received preoperative immunotherapy (n=31) versus upfront surgery (n=78) based on clinical T stage, surgical approach, gender, age, and year of surgery.

Preoperative clinical characteristics and 90-day surgical complications were identified, and differences between the preoperative immunotherapy and upfront surgery groups were quantified. Researchers noted that most patients were clinical T stage 3 or higher (67.7% vs 70.5%, respectively), had clear cell histology (80.8% vs 77.4%), and underwent an open surgical approach (58.1% vs 70.5%) rather than a robotic approach.

No differences were reported in operative duration, blood loss, and median length of hospital stay. However, the preoperative immunotherapy group was more likely to be transfused with greater than 1 unit of packed red blood cells.

Additionally, researchers reported no statistical differences in complications between the 2 groups. Most complications were minor, and the most commonplace complications were infectious and respiratory.

Dr. Reese and colleagues concluded that their propensity score-matched cohort showed “nephrectomy after systemic immunotherapy had similar operative characteristics and 90-day postoperative complications.”