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. 2018 Jul 30;16(4):378-385.
doi: 10.1016/j.aju.2018.06.005. eCollection 2018 Dec.

Radical nephrectomy and intracaval thrombectomy for advanced renal cancer with extensive inferior vena cava involvement utilising cardiopulmonary bypass and hypothermic circulatory arrest: Is it worthwhile?

Hosam Serag  1 , Jonathan M Featherstone  1 , David F Griffiths  2 , Dheeraj Mehta  3 , John Dunne  4 , Owen Hughes  1 , Philip N Matthews  1
Affiliations

Radical nephrectomy and intracaval thrombectomy for advanced renal cancer with extensive inferior vena cava involvement utilising cardiopulmonary bypass and hypothermic circulatory arrest: Is it worthwhile?

Hosam Serag et al. Arab J Urol. .

Abstract

Objective: To report our long-term outcomes of surgical treatment of renal tumours with inferior vena cava (IVC) tumour thrombus above the hepatic veins, utilising cardiopulmonary bypass (CBP) and hypothermic circulatory arrest (HCA), as surgical resection remains the only effective treatment for renal cancers with extensive IVC tumour thrombus.

Patients and methods: We retrospectively reviewed 48 consecutive patients (median age 58 years) who underwent surgical treatment for non-metastatic renal cancer with IVC tumour thrombus extending above the hepatic veins. Perioperative, histological, disease-free (DFS) and overall survival (OS) data were recorded.

Results: Tumour thrombus was level III in 23 patients and level IV in 25 patients. The median (range) CBP and HCA times were 162 (120-300) min and 35 (9-64) min, respectively. Three patients underwent synchronous cardiac surgical procedures. There were three (6.3%) perioperative deaths. American Society of Anesthesiologists grade and perioperative blood transfusion requirement were significant factors associated with perioperative death (P < 0.05). Despite extensive preoperative screening for metastases the median (range) DFS was only 10.2 (1.2-224.4) months. The median (range) OS was 23 (0-224.4) months. Cox regression analysis revealed that perinephric fat invasion conferred a significantly poorer DFS (P = 0.005).

Conclusions: Radical surgery for patients with extensive IVC tumour thrombus has acceptable operative morbidity and mortality. It provides symptom palliation and the possibility of long-term survival. Improvements in preoperative detection of occult metastasis may improve case selection and newer adjuvant therapies may improve survival in this high-risk group.

Keywords: ASA, American Society of Anesthesiologists; Advanced renal cancer; CPB, cardiopulmonary bypass; Cardiopulmonary bypass; DFS, disease-free survival; HCA, hypothermic circulatory arrest; Hypothermic circulatory arrest; IVC, inferior vena cava; Inferior vena cava thrombectomy; Level IV caval thrombus; MOF, multi-organ failure; OS, overall survival.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier curve: DFS.
Fig. 2
Fig. 2
Kaplan–Meier curve: OS.
Fig. 3
Fig. 3
Kaplan–Meier curve: DFS with and without perinephric fat invasion.
Fig. 4
Fig. 4
Kaplan–Meier curve: OS by HCA time.
See this image and copyright information in PMC

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