Surgical Treatment Strategy with Combined Cardiopulmonary Bypass for Renal Cell Carcinoma with Tumor Embolism Developed in Inferior Vena Cava

Authors

  • Tomohiro Imazuru Department of Cardiovascular Surgery, Teikyo University, Tokyo, Japan
  • Masateru Uchiyama Department of Cardiovascular Surgery, Teikyo University, Tokyo, Japany
  • Tomoki Shimokawa Department of Cardiovascular Surgery, Teikyo University, Tokyo, Japan

DOI:

https://doi.org/10.1532/hsf.2741

Abstract

Objective: Renal cell carcinoma (RCC) with tumor thrombus in the inferior vena cava (IVC) presents surgeons with a technical intraoperative challenge because of the need for aggressive surgical management. In this study, we describe our method for surgical management with cardiopulmonary bypass (CPB) and investigate the long-term outcomes of RCC patients with and without CPB.

Methods: Fifteen patients with RCC underwent nephrectomy and IVC thrombectomy from May 2011 to December 2017. We retrospectively reviewed and analyzed the clinical course of all patients. Novick classification was used to assess the level of tumor thrombus extension into the IVC. Patient characteristics, surgical procedures, and postoperative outcome data in both groups were collected.

Results: Twelve patients were male and 3 were female, with an average age of 62.9 ± 10.9 years (range 46 to 82). The average operative times were 824 ± 335 minutes in the patients with CPB and 646 ± 162 minutes in those without CPB (P = .17). The average amount of intraoperative bleeding was 2125 ± 1315 ml in the patients with CPB and 3333 ± 1431 ml in those without CPB (P = .14). The same tendency was observed in patients of Novick levels 3 and 4. The mean observation period was 1061.4 days. No 30-day mortality was noted. There was no significant difference in all-cause survival between the patients with CPB and those without.

Conclusions: We conclude that surgical management with CPB and circulatory arrest may be a viable and safe method of treatment for RCC patients.

References

Ali AS, Vasdev N, Shanmuganathan S, et al. 2013. The surgical management and prognosis of renal cell cancer with IVC tumor thrombus: 15-years of experience using a multi-specialty approach at a single UK referral center. Urol Oncol 31:1298-1304.

Bachmann A, Seitz M, Graser A, et al. 2005. Tumour nephrectomy with vena cava thrombus. BJU Int 95:1373-1384.

Belis JA, Levinson ME, Pae WE Jr. 2000. Complete radical nephrectomy and vena caval thrombectomy during circulatory arrest. J Urol 163:434-436.

Blute ML, Leibovich BC, Lohse CM, et al. 2004. The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int 94:33-41.

Carrascal Y, Gualis J, Arévalo A. 2008. Cardiac surgery with extracorporeal circulation in cancer patients: Influence on surgical morbidity and mortality and survival. Rev Esp Cardiol 61:369-375.

Chan F, Ngan Kee WD, Low JM. 2001. Anesthetic management of renal cell carcinoma with inferior vena caval extension. J Clin Anesth 13:585-587.

Chowdhury UK, Mishra AK, Seth A, et al. 2007. Novel techniques for tumor thrombectomy for renal cell carcinoma with intraatrial tumor thrombus. Ann Thorac Surg 83:1731-1736.

Ciancio G, Livingstone AS, Soloway M. 2007. Surgical management of renal cell carcinoma with tumor thrombus in the renal and inferior vena cava: The University of Miami experience in using liver transplantation techniques. Eur Urol 51:988-994.

Ciancio G, Manoharan M, Katkoori D, et al. 2010. Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: Single-center experience. Eur Urol 57:667-672.

Ciancio G, Soloway MS. 2005. Renal cell carcinoma with tumor thrombus extending above diaphragm: avoiding cardiopulmonary bypass. Urology 66:266-270.

Dellaportas D, Arkadopoulos N, Tzanoglou I, et al. 2017. Technical intraoperative maneuvers for the management of inferior vena cava thrombus in renal cell carcinoma. Front Surg 4:48.

Dindo D, Demartines N, Clavien PA. 2004. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205-213.

Dominik J, Moravek P, Zacek P, et al. 2013. Long-term survival after radical surgery for renal cell carcinoma with tumour thrombus extension into the right atrium. BJU Int 111:E59-E64.

Fuhrman SA, Lasky LC, Limas C. 1982. Prognostic significance of morphologic parameters in renal cell carcinoma. Am J Surg Pathol 6:655-663.

Janzen NK, Kim HL, Figlin RA, et al. 2003. Surveillance after radical or partial nephrectomy for localized renal cell carcinoma and management of recurrent disease. Urol Clin North Am 30:843-852.

Jemal A, Siegel R, Xu J, et al. 2010. Cancer statistics, 2010. CA Cancer J Clin 60:277-300.

Kaplan S, Ekici S, Doğan R, et al. 2002. Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus. Am J Surg 183:292-299.

Karnes RJ, Blute ML. 2008. Surgery insight: Management of renal cell carcinoma with associated inferior vena cava thrombus. Nat Clin Pract Urol 5:329-339.

Langer NB, Mercier O, Fabre D, et al. 2016. Outcomes after resection of T4 non-small cell lung cancer using cardiopulmonary bypass. Ann Thorac Surg 102:902-910.

Lawindy SM, Kurian T, Kim T, et al. 2012. Important surgical considerations in the management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumour thrombus. BJU Int 110:926-939.

Magouliotis DE, Tasiopoulou VS, Svokos AA, et al. 2018. Extracorporeal membrane oxygenation versus cardiopulmonary bypass during lung transplantation: A meta-analysis. Gen Thorac Cardiovasc Surg 66:38-47.

Marshall FF, Dietrick DD, Baumgartner WA, et al. 1988. Surgical management of renal cell carcinoma with intracaval neoplastic extension above the hepatic veins. J Urol 139:1166-1172.

Neves RJ, Zincke H. 1987. Surgical treatment of renal cancer with vena cava extension. Br J Urol 59:390-395.

Novick AC, Kaye MC, Cosgrove DM, et al. 1990. Experience with cardiopulmonary bypass and deep hypothermic circulatory arrest in the management of retroperitoneal tumors with large vena caval thrombi. Ann Surg 212:472-476; discussion 476-477.

Pinto CA, Marcella S, August DA, et al. 2013. Cardioplumonary bypass has a modest association with cancer progression: A retrospective cohort study. BMC Cancer 13:519.

Sablotzki A, Welters I, Lehmann N, et al. 1997. Plasma levels of immunoinhibitory cytokines interleukin-10 and transforming growth factor-beta in patients undergoing coronary artery bypass grafting. Eur J Cardiothorac Surg 11:763-768.

Shuch B, Crispen PL, Leibovich BC, et al. 2011. Cardiopulmonary bypass and renal cell carcinoma with level IV tumour thrombus: Can deep hypothermic circulatory arrest limit perioperative mortality? BJU Int 107:724-728.

Staehler G, Brkovic D. 2000. The role of radical surgery for renal cell carcinoma with extension into the vena cava. J Urol 163:1671-1675.

Published

2020-02-10

How to Cite

Imazuru, T., Uchiyama, M., & Shimokawa, T. (2020). Surgical Treatment Strategy with Combined Cardiopulmonary Bypass for Renal Cell Carcinoma with Tumor Embolism Developed in Inferior Vena Cava. The Heart Surgery Forum, 23(1), E025-E029. https://doi.org/10.1532/hsf.2741

Issue

Section

Articles