Prevalence of perioperative pulmonary embolism in patients with renal cell carcinoma undergoing nephrectomy

Abstract

This study aims to determine the prevalence of perioperative PE and outcomes in patients with RCC scheduled for nephrectomy. A total of 418 patients were included in this single-center, observational study. Three hundred patients with RCC were retrospectively reviewed between 2016 and 2020, and the remaining patients were prospectively collected between 2020 and 2022 to minimize the effect of the long-time span. Patients with incomplete medical data and those who refused to participate were excluded. The primary outcome was the prevalence of perioperative PE. Secondary outcomes were associated factors, method of PE prophylaxis, rate of intraoperative transesophageal echocardiography (TEE) utilization, and 30-day mortality. The prevalence of perioperative PE was 1.9 % and most commonly occurred during the postoperative period (75 %). The prevalence rose to 7.5 % in patients with tumor thrombus. Significant factors related to PE included smoking (OR 6.78, 95 % CI 1.13–40.56) and change in tumor thrombus stage (OR 21.55, 95 % CI 3.69–125.71). There was no difference in the rate or method of PE prophylaxis between the two groups. Of the patients, 2.9 % underwent intraoperative TEE monitoring and 0.2 % received rescue TEE. Pneumonia and acute respiratory distress syndrome were significantly correlated with PE (P < 0.001 and P = 0.03, respectively). Finally, there was no significant difference in 30-day mortality (P = 0.07). The overall prevalence of PE in patients with RCC scheduled for nephrectomy was rare but more likely to occur in those with tumor thrombus.

Keywords

• Pulmonary embolism
• Renal cell carcinoma
• Nephrectomy
• Tumor thrombus
• Perioperative