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- Title
Cardiopulmonary bypass and renal cell carcinoma with level IV tumour thrombus: can deep hypothermic circulatory arrest limit perioperative mortality?
- Authors
Shuch, Brian; Crispen, Paul L.; Leibovich, Bradley C.; LaRochelle, Jeff C.; Pouliot, Frederic; Pantuck, Allan J.; Liu, Weiqing; Crepel, Maxime; Schuckman, Anne; Rigaud, Jerome; Bouchot, Oliver; Patard, Jean-Jacques; Skinner, Donald; Belldegrun, Arie S.; Blute, Michael L.
- Abstract
OBJECTIVE • To review experience with nephrectomy/thrombectomy for a renal cell carcimoma (RCC) with a level IV tumour thrombus and to evaluate the benefit of deep hypothermic circulatory arrest (DHCA) with cardiopulmonary bypass (CPBP). PATIENTS AND METHODS • A multi-institutional retrospective database was created to assess the outcomes of surgery for RCC and associated level IV tumour thrombus from 1983 to 2007. Patients were identified based on radiographic records/operative findings. • Only cases using CPBP were analysed. Clinicopathological and operative characteristics including use of DHCA were recorded. • Overall survival (OS) for all patients and by use of DHCA was assessed. Comparisons of clinical and operative characteristics by use of DHCA were performed. • A Cox regression model determined predictors of perioperative/in-hospital mortality. RESULTS • In all, 63 patients underwent resection with CPBP; overall perioperative mortality was 22.2%. • There were no significant differences in clinicopathological characteristics, operative duration, estimated blood loss, transfusions, and hospital stay by use of DHCA. • Perioperative mortality rate was lower in patients undergoing DHCA (8.3% vs 37.5%, P = 0.006). • The median OS was longer for the patients undergoing DHCA (15.8 vs 7.7 months); however, this failed to reach statistical significance ( P = 0.357). • On multivariate analysis, age of > 60 years (hazard ratio [HR] 6.7, 95% confidence interval [CI] 1.5-31.1, P = 0.015) and the use of DHCA (HR 0.13, 95% CI 0.036-0.51, P = 0.003) were independent predictors of perioperative mortality. CONCLUSIONS • Radical nephrectomy and level IV tumour thrombectomy is associated with significant mortality. • The use of DHCA does not appear to adversely affect operative characteristics and may limit perioperative mortality. • Further prospective studies should be performed to confirm the benefit of DHCA.
- Subjects
RENAL cell carcinoma; TUMORS; CARDIOPULMONARY bypass; SURGERY; MORTALITY; REGRESSION analysis
- Publication
BJU International, 2011, Vol 107, Issue 5, p724
- ISSN
1464-4096
- Publication type
Article
- DOI
10.1111/j.1464-410X.2010.09488.x