Postoperative Complications From Cytoreductive Nephrectomy After Neoadjuvant Targeted Therapy For Metastatic Renal Cell Carcinoma

300 Background: Neoadjuvant treatment of metastatic renal cell carcinoma (RCC) with targeted systemic therapies is under investigation. Postoperative complications that occurred after cytoreductive nephrectomy (CRN) preceded by neoadjuvant systemic therapy were assessed. Methods: A retrospective review of all patients with clinical evidence of metastasis that underwent CRN was performed. Of 683 surgical patients with metastatic disease, 67 had received preoperative targeted therapy. Preoperative, operative, and postoperative characteristics were evaluated for each patient. Surgical complications were assessed using the modified Clavien system. A multivariate was sued to determine preoperative variables in an attempt to predict surgical complications within 1 year of CRN. Results: Complications occurred in 64% (43/67) of patients within 365 days of CRN. Clavien grade ≥ 3 complications occurred in 30% (20/67) patients. The most common occurrences were superficial wound dehiscence (25%), and wound infection (15%). On univariate analysis there were no statistically significant differences between groups in regards to age, race, gender, smoking history, follow-up, Charlson comorbidity index, MSKCC risk groups, or time from cessation of targeted therapy to surgery. Significant predictors of complications included BMI ≥ 30 (p=0.007), EBL (p=0.019), matted nodes (p=0.043), and surgical approach (p=0.001). Clinical T-stage and N-stage (p=0.068, p=0.073) approached significance. On multivariate analysis Charlson comorbidity index ≥ 8(OR 5.2, 95% CI 1.23, 21.99) and clinical N-stage (OR 5.11, 95%CI 1.21, 21.66) were significant predictors of postoperative complications. Conclusions: In this series of patients treated with neoadjuvant targeted therapy, a majority of patients experienced a postoperative complication after CRN. A Charlson comorbidity index ≥ 8 or clinical node positivity predicted for an increased risk of postoperative complications. The use of neoadjuvant systemic targeted therapy prior to CRN is investigational and adequate assessment of operative morbidity is needed prior to wide spread adoption. No significant financial relationships to disclose.