Who is dying after nephrectomy for cancer? Study of risk factors and causes of death after analyzing morbidity and mortality reviews (UroCCR-33 study).

Nephrectomy is the treatment for renal cell cancer from T1-4 tumors but remains at risk. To determine the thirty-day mortality rate after nephrectomy for cancer and to identify causes and risk factors of death in order to find clinical applications. From 2014 to 2017, we performed a retrospective multicentric analysis of prospectively collected data study involving the French network for research on kidney cancer (UroCCR). All patients who died after nephrectomy for cancer during the first thirty days were identified. Patients' characteristics, causes of death and morbidity and mortality reviews reports were analyzed for each death.

In total, 2578 patients underwent nephrectomy and 35 deaths occurred. The thirty-day mortality rate was 1.4%. In univariate analysis, symptoms at diagnosis (P=0.006, OR=2.56 IC (1.3-5.03)), c stage superior to cT1 (P<0.0001, OR=6.13 IC (2.8-13.2)), cT stage superior to cT2 (P<0.0001, OR=8.8 IC (4.39-17.8)), nodal invasion (P<0.0001, OR=4.6 IC (1.9-10.7)), distant metastasis (P=0.001, OR=4.01 IC (1.7-8.9)), open surgery (P<0.0001, OR=0.272 IC (0.13-0.54)) and radical nephrectomy (P=0.007, OR=2.737 IC (1.3-5.7)) were risk factors of thirty-day mortality. In a multivariable model, only cT stage superior to T2 (P=0.015, OR=3.55 IC (1.27-10.01)) was a risk factor of thirty-day mortality. The main cause of postoperative death was pulmonary (n=15; 43%). The second cause was postoperative digestive sepsis for 7 patients (20%). Only 2 morbidity and mortality reviews had been done for the 35 deaths. Limitations are related to the thirty-day mortality criteria and descriptive study design.

Symptomatic patients, stage cTNM and type and techniques of surgery are determinants of thirty-day mortality after nephrectomy for cancer. The first cause of postoperative death is pulmonary. Morbidity and mortality reviews should be considered to better understand causes of death and to reduce early mortality after nephrectomy for cancer.


Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2019 Apr 05 [Epub]

A Fontenil, P Bigot, J-C Bernhard, J-B Beauval, M Soulié, T Charles, S Larre, L Salomon, R Azzouzi, A Méjean, K Bensalah, Cancerology Committee of the French Association of Urology (CCAFU)

Department of urology, Angers university hospital, 4, rue Larrey, 49933 Angers, France. Electronic address: ., Department of urology, Angers university hospital, 4, rue Larrey, 49933 Angers, France., Department of urology, Bordeaux university hospital, 33000 Bordeaux, France., Department of urology, Toulouse university hospital, 31400 Toulouse, France., Department of urology, Poitiers university hospital, 86021 Poitiers, France., Department of urology, Reims university hospital, 51100 Reims, France., Department of urology, Henri-Mondor university hospital, 94010 Créteil, France., Department of urology, HEGP, 75015 Paris, France., Department of urology, Rennes university hospital, 35000 Rennes, France.