Symptomatic Venous Thromboembolism is Associated with Inferior Survival among Patients Undergoing Nephrectomy with Inferior Vena Cava Tumor Thrombectomy for Renal Cell Carcinoma

Paras H. Shah, R. Houston Thompson, Stephen A. Boorjian, Christine M. Lohse, Timothy D. Lyon, Raymond C. Shields, David Froehling, Bradley C. Leibovich, Boyd R. Viers

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose: We investigated the incidence and survival impact of symptomatic venous thromboembolism after nephrectomy with inferior vena cava tumor thrombectomy. Materials and Methods: We retrospectively reviewed the records of 183 patients who underwent nephrectomy with inferior vena cava tumor thrombectomy (level I-IV) for renal cell carcinoma between 2000 and 2010. Postoperative venous thromboembolism was defined as symptomatic bland thrombus or embolism confirmed on imaging. The cumulative incidence of venous thromboembolism was estimated by the Kaplan-Meier method. Associations of clinicopathological features with time to thromboembolism after surgery and all cause mortality were evaluated on multivariable analysis with Cox models. Results: Symptomatic venous thromboembolism developed in 55 patients a median of 23 days (IQR 5–142) postoperatively, including pulmonary thrombosis in 24, deep venous thrombosis in 17, bland inferior vena cava thrombosis in 13 and portal vein thrombosis in 1. The cumulative incidence of thromboembolism 30, 90 and 365 days following surgery was 17%, 22% and 27%, respectively. A history of smoking (HR 2.15, 95% CI 1.09–4.24, p = 0.028), ECOG (Eastern Cooperative Oncology Group) performance status 1 or greater (HR 2.15, 95% CI 1.17–3.93, p = 0.013), hypercoagulability disorder (HR 5.12, 95% CI 1.93–13.59, p = 0.001) and bulky lymphadenopathy at surgery (HR 4.84, 95% CI 1.87–12.51, p = 0.001) was significantly associated with an increased risk of venous thromboembolism on multivariable analysis. Postoperative venous thromboembolism was significantly associated with an increased risk of all cause mortality (HR 1.53, 95% CI 1.04–2.23, p = 0.029). Conclusions: Venous thromboembolism after nephrectomy and tumor thrombectomy is common within 90 days of surgery. Symptomatic venous thromboembolism in this population is independently associated with a greater risk of mortality.

Original languageEnglish (US)
Pages (from-to)520-527
Number of pages8
JournalJournal of Urology
Volume200
Issue number3
DOIs
StatePublished - Sep 1 2018

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Thrombectomy
Venous Thromboembolism
Inferior Vena Cava
Nephrectomy
Renal Cell Carcinoma
Survival
Neoplasms
Thrombosis
Thromboembolism
Ambulatory Surgical Procedures
Mortality
Incidence
Thrombophilia
Portal Vein
Embolism
Proportional Hazards Models
Venous Thrombosis
Smoking
Lung

Keywords

  • carcinoma
  • inferior
  • kidney
  • nephrectomy
  • renal cell
  • thromboembolism
  • vena cava
  • venous

ASJC Scopus subject areas

  • Urology

Cite this

Symptomatic Venous Thromboembolism is Associated with Inferior Survival among Patients Undergoing Nephrectomy with Inferior Vena Cava Tumor Thrombectomy for Renal Cell Carcinoma. / Shah, Paras H.; Thompson, R. Houston; Boorjian, Stephen A.; Lohse, Christine M.; Lyon, Timothy D.; Shields, Raymond C.; Froehling, David; Leibovich, Bradley C.; Viers, Boyd R.

In: Journal of Urology, Vol. 200, No. 3, 01.09.2018, p. 520-527.

Research output: Contribution to journalArticle

Shah, Paras H. ; Thompson, R. Houston ; Boorjian, Stephen A. ; Lohse, Christine M. ; Lyon, Timothy D. ; Shields, Raymond C. ; Froehling, David ; Leibovich, Bradley C. ; Viers, Boyd R. / Symptomatic Venous Thromboembolism is Associated with Inferior Survival among Patients Undergoing Nephrectomy with Inferior Vena Cava Tumor Thrombectomy for Renal Cell Carcinoma. In: Journal of Urology. 2018 ; Vol. 200, No. 3. pp. 520-527.
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abstract = "Purpose: We investigated the incidence and survival impact of symptomatic venous thromboembolism after nephrectomy with inferior vena cava tumor thrombectomy. Materials and Methods: We retrospectively reviewed the records of 183 patients who underwent nephrectomy with inferior vena cava tumor thrombectomy (level I-IV) for renal cell carcinoma between 2000 and 2010. Postoperative venous thromboembolism was defined as symptomatic bland thrombus or embolism confirmed on imaging. The cumulative incidence of venous thromboembolism was estimated by the Kaplan-Meier method. Associations of clinicopathological features with time to thromboembolism after surgery and all cause mortality were evaluated on multivariable analysis with Cox models. Results: Symptomatic venous thromboembolism developed in 55 patients a median of 23 days (IQR 5–142) postoperatively, including pulmonary thrombosis in 24, deep venous thrombosis in 17, bland inferior vena cava thrombosis in 13 and portal vein thrombosis in 1. The cumulative incidence of thromboembolism 30, 90 and 365 days following surgery was 17{\%}, 22{\%} and 27{\%}, respectively. A history of smoking (HR 2.15, 95{\%} CI 1.09–4.24, p = 0.028), ECOG (Eastern Cooperative Oncology Group) performance status 1 or greater (HR 2.15, 95{\%} CI 1.17–3.93, p = 0.013), hypercoagulability disorder (HR 5.12, 95{\%} CI 1.93–13.59, p = 0.001) and bulky lymphadenopathy at surgery (HR 4.84, 95{\%} CI 1.87–12.51, p = 0.001) was significantly associated with an increased risk of venous thromboembolism on multivariable analysis. Postoperative venous thromboembolism was significantly associated with an increased risk of all cause mortality (HR 1.53, 95{\%} CI 1.04–2.23, p = 0.029). Conclusions: Venous thromboembolism after nephrectomy and tumor thrombectomy is common within 90 days of surgery. Symptomatic venous thromboembolism in this population is independently associated with a greater risk of mortality.",
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AU - Shah, Paras H.

AU - Thompson, R. Houston

AU - Boorjian, Stephen A.

AU - Lohse, Christine M.

AU - Lyon, Timothy D.

AU - Shields, Raymond C.

AU - Froehling, David

AU - Leibovich, Bradley C.

AU - Viers, Boyd R.

PY - 2018/9/1

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N2 - Purpose: We investigated the incidence and survival impact of symptomatic venous thromboembolism after nephrectomy with inferior vena cava tumor thrombectomy. Materials and Methods: We retrospectively reviewed the records of 183 patients who underwent nephrectomy with inferior vena cava tumor thrombectomy (level I-IV) for renal cell carcinoma between 2000 and 2010. Postoperative venous thromboembolism was defined as symptomatic bland thrombus or embolism confirmed on imaging. The cumulative incidence of venous thromboembolism was estimated by the Kaplan-Meier method. Associations of clinicopathological features with time to thromboembolism after surgery and all cause mortality were evaluated on multivariable analysis with Cox models. Results: Symptomatic venous thromboembolism developed in 55 patients a median of 23 days (IQR 5–142) postoperatively, including pulmonary thrombosis in 24, deep venous thrombosis in 17, bland inferior vena cava thrombosis in 13 and portal vein thrombosis in 1. The cumulative incidence of thromboembolism 30, 90 and 365 days following surgery was 17%, 22% and 27%, respectively. A history of smoking (HR 2.15, 95% CI 1.09–4.24, p = 0.028), ECOG (Eastern Cooperative Oncology Group) performance status 1 or greater (HR 2.15, 95% CI 1.17–3.93, p = 0.013), hypercoagulability disorder (HR 5.12, 95% CI 1.93–13.59, p = 0.001) and bulky lymphadenopathy at surgery (HR 4.84, 95% CI 1.87–12.51, p = 0.001) was significantly associated with an increased risk of venous thromboembolism on multivariable analysis. Postoperative venous thromboembolism was significantly associated with an increased risk of all cause mortality (HR 1.53, 95% CI 1.04–2.23, p = 0.029). Conclusions: Venous thromboembolism after nephrectomy and tumor thrombectomy is common within 90 days of surgery. Symptomatic venous thromboembolism in this population is independently associated with a greater risk of mortality.

AB - Purpose: We investigated the incidence and survival impact of symptomatic venous thromboembolism after nephrectomy with inferior vena cava tumor thrombectomy. Materials and Methods: We retrospectively reviewed the records of 183 patients who underwent nephrectomy with inferior vena cava tumor thrombectomy (level I-IV) for renal cell carcinoma between 2000 and 2010. Postoperative venous thromboembolism was defined as symptomatic bland thrombus or embolism confirmed on imaging. The cumulative incidence of venous thromboembolism was estimated by the Kaplan-Meier method. Associations of clinicopathological features with time to thromboembolism after surgery and all cause mortality were evaluated on multivariable analysis with Cox models. Results: Symptomatic venous thromboembolism developed in 55 patients a median of 23 days (IQR 5–142) postoperatively, including pulmonary thrombosis in 24, deep venous thrombosis in 17, bland inferior vena cava thrombosis in 13 and portal vein thrombosis in 1. The cumulative incidence of thromboembolism 30, 90 and 365 days following surgery was 17%, 22% and 27%, respectively. A history of smoking (HR 2.15, 95% CI 1.09–4.24, p = 0.028), ECOG (Eastern Cooperative Oncology Group) performance status 1 or greater (HR 2.15, 95% CI 1.17–3.93, p = 0.013), hypercoagulability disorder (HR 5.12, 95% CI 1.93–13.59, p = 0.001) and bulky lymphadenopathy at surgery (HR 4.84, 95% CI 1.87–12.51, p = 0.001) was significantly associated with an increased risk of venous thromboembolism on multivariable analysis. Postoperative venous thromboembolism was significantly associated with an increased risk of all cause mortality (HR 1.53, 95% CI 1.04–2.23, p = 0.029). Conclusions: Venous thromboembolism after nephrectomy and tumor thrombectomy is common within 90 days of surgery. Symptomatic venous thromboembolism in this population is independently associated with a greater risk of mortality.

KW - carcinoma

KW - inferior

KW - kidney

KW - nephrectomy

KW - renal cell

KW - thromboembolism

KW - vena cava

KW - venous

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