Postoperative Complications and Long-Term Survival Among Patients Treated Surgically for Renal Cell Carcinoma

PURPOSE: In addition to their acute implications, adverse events after oncological surgery may have late or long-term consequences for patient outcomes. We assessed the relationship between postoperative complications and long-term survival among patients treated surgically for kidney cancer. MATERIALS AND METHODS: Using Surveillance, Epidemiology and End Results-Medicare data we identified patients with kidney cancer treated surgically from 1995 through 2005. After excluding from analysis those who died during the index hospitalization or within 30 days of surgery we compared overall survival for patients with or without a postoperative complication. We then fit multivariate Cox proportional hazard models to estimate the association between complications and long-term survival, adjusting for patient characteristics, cancer severity and surgical approach. RESULTS: We identified 4,687 (37%) and 7,931 patients (63%) with and without a postoperative complication, respectively. During a median followup of 32 months (range 1 to 132) 3,425 patients (27.1%) died of any cause. Patients with at least 1 postoperative complication had lower unadjusted 5-year survival (59.9% vs 69.5%, p <0.001). On multivariate analyses the occurrence of a complication was also associated with significantly worse long-term survival (HR 1.24, 95% CI 1.16-1.33). This relationship was consistent with time, across surgical approaches and among patients with various specific complications, including acute renal failure, cardiac and neurological events, postoperative infection and sepsis. CONCLUSIONS: The occurrence of a postoperative complication is associated with decreased long-term survival after surgery for kidney cancer. Clarification of the cascade of events underlying this relationship may lead to new strategies to improve outcomes among cancer survivors.