Describing postoperative complications and the perioperative associations of curative surgery for renal cell carcinoma at a South African centre

Abstract

Background: Adverse events after renal oncological surgery have a marked impact on the postoperative course with many identifiable determinants. However, data are mainly from American and European centres, and it is uncertain whether the same risk factors for adverse events apply in the South African or wider African context. We provide an accurate description of postoperative complications and assess the potential perioperative associations.

Methods: A retrospective cohort study was done by reviewing records of patient who received curative surgery for either confirmed or suspected renal cell carcinoma (RCC). The primary outcome was to assess the complication rate during the first year after surgery and describe postoperative complications according to the Clavien–Dindo (CD) classification system. Patient demographics, comorbidity and operative data were considered to have a potential association with complications. A multivariable logistic regression analysis assessed variables with statistically significant associations.

Results: We collected data from 107 patients. The complication rate was 29%, with most complications (83.9%) being of low grade. The remainder (16.1%) experienced high-grade complications and no mortalities were noted. Surgical approach (favouring laparoscopy) (p = 0.025), presence of perioperative transfusions (25.2%; p < 0.001) and perioperative blood loss (50–500; > 1 000 ml; p < 0.001) all showed a significant association with postoperative complications. Following the multivariable logistic regression, only blood loss > 1 000 ml maintained significance.

Conclusion: Overall, complication rates and severity were low. However, there is room for improvement in increasing the amount of minimally invasive procedures, and implementing a formal postoperative recovery plan such as the enhanced recovery after surgery (ERAS) programme.