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. 2018 Jul 5;13(1):85.
doi: 10.1186/s13019-018-0772-z.

The role of deep hypothermic circulatory arrest in surgery for renal or adrenal tumor with vena cava thrombus: a single-institution experience

Peng Zhu  1 , Songlin Du  1 , Shijun Chen  2 , Shaobin Zheng  2 , Yu Hu  1 , Li Liu  1 , Shaoyi Zheng  3
Affiliations

The role of deep hypothermic circulatory arrest in surgery for renal or adrenal tumor with vena cava thrombus: a single-institution experience

Peng Zhu et al. J Cardiothorac Surg. .

Abstract

Background: The aim of this study was to review our experience in managing renal or adrenal tumors with level III or IV inferior vena cava thrombus by using deep hypothermic circulatory arrest (DHCA), and to evaluate survival outcomes.

Methods: Between September 2004 and March 2016, we treated 33 patients with renal or adrenal malignancy tumor and thrombus extending into the inferior vena cava. Patients were identified according to radiographic records and operative findings. Clinicopathological and operative characteristics were recorded, and comparisons of clinical and operative characteristics through DHCA were performed. A Cox regression model was used to determine predictors of perioperative mortality.

Results: Twenty-one out of 33 patients with level III (n = 15), level IV (n = 5), or level II (n = 1) renal or adrenal tumors were treated surgically through cardiopulmonary bypass (CPB) with DHCA, and 12 patients with level II or III tumors were treated surgically through normothermic CPB. Three complications were observed, and one death occurred perioperatively, owing to multiple organ failure. The overall perioperative mortality was 4.7%. There were significant differences in the clinicopathological characteristics, operative duration, estimated blood loss, transfusions and hospital stay depending on use of DHCA. Multivariate analysis indicated that the operative duration (OR, 3.78; P < 0.001), estimated blood loss (OR, 1.08; P = 0.02), and transfusion (OR, 2.13; P = 0.038) during/after surgery were positively associated with higher mortality and morbidity. DHCA failed to reach statistical significance (P = 0.378).

Conclusions: Use of CPB and DHCA to treat renal or adrenal tumors allows for complete tumor resection, especially at the T4 stage. Although it can cause physical damage, this technique does not increase operative risk and is a relatively safe approach.

Keywords: Cardiopulmonary bypass; Hypothermic arrest; Renal tumor; Thrombectomy.

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Conflict of interest statement

Ethics approval and consent to participate

Study protocol was approved by the Ethical Committee of the NanFang Hospital, Southern Medical University.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The Mayo classification of macroscopic venous invasion in RCC. Level I: The tumor thrombus is either at the entry of the renal vein or within the IVC < 2 cm from the confluence of the renal vein and the IVC. Level II: The thrombus extends within the IVC > 2 cm above the confluence of the renal vein and the IVC but still remains below the hepatic veins. Level III: The thrombus involves the intrahepatic IVC. The size of the thrombus ranges from a narrow tail that extends into the IVC to one that fills the lumen and enlarges the IVC. Level IV: The thrombus extends above the diaphragm or into the right atrium
Fig. 2
Fig. 2
MRI of a left-sided RCC with right atrial tumor thrombus (*)
Fig. 3
Fig. 3
Incisions used for a right-sided tumor. a An abdominal rectus incision was made to expose the right renal and IVC. b CPB and DHCA were performed through a chest median incision
Fig. 4
Fig. 4
Without blood, the thrombus (arrow) of the hepatic segment was excised and plastic IVC was performed. The right-sided RCC(*)
Fig. 5
Fig. 5
A right-sided RCC with right atrial tumor thrombus invasion
See this image and copyright information in PMC

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