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. 1990 Oct;212(4):472–477. doi: 10.1097/00000658-199010000-00010

Experience with cardiopulmonary bypass and deep hypothermic circulatory arrest in the management of retroperitoneal tumors with large vena caval thrombi.

A C Novick 1, M C Kaye 1, D M Cosgrove 1, K Angermeier 1, J E Pontes 1, J E Montie 1, S B Streem 1, E Klein 1, R Stewart 1, M Goormastic 1
PMCID: PMC1358282  PMID: 2222013

Abstract

From June 1984 to September 1989, 43 patients with large vena caval tumor thrombi from retroperitoneal malignancies underwent surgical treatment with cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). The primary malignancies were renal cell carcinoma (RCC) (n = 39), renal pelvic transitional cell carcinoma (n = 1), adrenal pheochromocytoma (n = 1), and renal (n = 1) or retroperitoneal (n = 1) sarcoma. The level of the caval thrombus was either suprahepatic (n = 27), intrahepatic (n = 14), or subhepatic (n = 2). In all cases the primary tumor and caval thrombus were completely removed. Concomitant procedures included coronary artery bypass grafting (n = 5), pulmonary resection (n = 2), and hepatic lobectomy (n = 1). The time of circulatory arrest ranged from 10 to 44 minutes (mean, 23.5 minutes). There were two operative deaths (4.7%), neither of them due to to the use of DHCA. Major postoperative complications occurred in 13 patients (30.2%). There were no ischemic or neurologic complications and no cases of perioperative tumor embolization. The median postoperative hospital stay was 9 days. Twenty-two patients (51%) are alive and enjoying a good quality of life. The 3-year patient survival rates in patients with localized (n = 24) versus metastatic (n = 15) RCC are 63.9% and 10.9%, respectively (p = 0.02). We conclude that CPB with DHCA facilities excision of retroperitoneal malignancies with large caval thrombi and provides the potential for cure with low morbidity and mortality rates.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Attwood S., Lang D. M., Goiti J., Grant J. Venous bypass for surgical resection of renal carcinoma invading the vena cava: a new approach. Br J Urol. 1988 May;61(5):402–405. doi: 10.1111/j.1464-410x.1988.tb06584.x. [DOI] [PubMed] [Google Scholar]
  2. Belis J. A., Pae W. E., Jr, Rohner T. J., Jr, Myers J. L., Thiele B. L., Wickey G. S., Martin D. E. Cardiovascular evaluation before circulatory arrest for removal of vena caval extension of renal carcinoma. J Urol. 1989 Jun;141(6):1302–1307. doi: 10.1016/s0022-5347(17)41288-2. [DOI] [PubMed] [Google Scholar]
  3. Bidstrup B. P., Royston D., Sapsford R. N., Taylor K. M. Reduction in blood loss and blood use after cardiopulmonary bypass with high dose aprotinin (Trasylol). J Thorac Cardiovasc Surg. 1989 Mar;97(3):364–372. [PubMed] [Google Scholar]
  4. Cherrie R. J., Goldman D. G., Lindner A., deKernion J. B. Prognostic implications of vena caval extension of renal cell carcinoma. J Urol. 1982 Nov;128(5):910–912. doi: 10.1016/s0022-5347(17)53273-5. [DOI] [PubMed] [Google Scholar]
  5. Cummings K. B., Li W. I., Ryan J. A., Horton W. G., Paton R. R. Intraoperative management of renal cell carcinoma with supradiaphragmatic caval extension. J Urol. 1979 Dec;122(6):829–832. doi: 10.1016/s0022-5347(17)56624-0. [DOI] [PubMed] [Google Scholar]
  6. Foster R. S., Mahomed Y., Bihrle R., Strup S. Use of a caval-atrial shunt for resection of a caval tumor thrombus in renal cell carcinoma. J Urol. 1988 Dec;140(6):1370–1371. doi: 10.1016/s0022-5347(17)42047-7. [DOI] [PubMed] [Google Scholar]
  7. Harker L. A. Bleeding after cardiopulmonary bypass. N Engl J Med. 1986 May 29;314(22):1446–1448. doi: 10.1056/NEJM198605293142209. [DOI] [PubMed] [Google Scholar]
  8. Libertino J. A., Zinman L., Watkins E., Jr Long-term results of resection of renal cell cancer with extension into inferior vena cava. J Urol. 1987 Jan;137(1):21–24. doi: 10.1016/s0022-5347(17)43859-6. [DOI] [PubMed] [Google Scholar]
  9. Marshall F. F., Reitz B. A. Technique for removal of renal cell carcinoma with suprahepatic vena caval tumor thrombus. Urol Clin North Am. 1986 Aug;13(3):551–557. [PubMed] [Google Scholar]
  10. Montie J. E., Jackson C. L., Cosgrove D. M., Streem S. B., Novick A. C., Pontes J. E. Resection of large inferior vena caval thrombi from renal cell carcinoma with the use of circulatory arrest. J Urol. 1988 Jan;139(1):25–28. doi: 10.1016/s0022-5347(17)42279-8. [DOI] [PubMed] [Google Scholar]
  11. Neves R. J., Zincke H. Surgical treatment of renal cancer with vena cava extension. Br J Urol. 1987 May;59(5):390–395. doi: 10.1111/j.1464-410x.1987.tb04832.x. [DOI] [PubMed] [Google Scholar]
  12. Novick A. C., Cosgrove D. M. Surgical approach for removal of renal cell carcinoma extending into the vena cava and the right atrium. J Urol. 1980 Jun;123(6):947–950. doi: 10.1016/s0022-5347(17)56207-2. [DOI] [PubMed] [Google Scholar]
  13. Pritchett T. R., Raval J. K., Benson R. C., Lieskovsky G., Colletti P. M., Boswell W. D., Jr, Skinner D. G. Preoperative magnetic resonance imaging of vena caval tumor thrombi: experience with 5 cases. J Urol. 1987 Nov;138(5):1220–1222. doi: 10.1016/s0022-5347(17)43556-7. [DOI] [PubMed] [Google Scholar]
  14. Schefft P., Novick A. C., Straffon R. A., Stewart B. H. Surgery for renal cell carcinoma extending into the inferior vena cava. J Urol. 1978 Jul;120(1):28–31. doi: 10.1016/s0022-5347(17)57028-7. [DOI] [PubMed] [Google Scholar]
  15. Skinner D. G., Pritchett T. R., Lieskovsky G., Boyd S. D., Stiles Q. R. Vena caval involvement by renal cell carcinoma. Surgical resection provides meaningful long-term survival. Ann Surg. 1989 Sep;210(3):387–394. doi: 10.1097/00000658-198909000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Sosa R. E., Muecke E. C., Vaughan E. D., Jr, McCarron J. P., Jr Renal cell carcinoma extending into the inferior vena cava: the prognostic significance of the level of vena caval involvement. J Urol. 1984 Dec;132(6):1097–1100. doi: 10.1016/s0022-5347(17)50050-6. [DOI] [PubMed] [Google Scholar]
  17. Welch M., Bazaral M. G., Schmidt R., Pontes J. E., Cosgrove D. M., Montie J. E., Novick A. C. Anesthetic management for surgical removal of renal carcinoma with caval or atrial tumor thrombus using deep hypothermic circulatory arrest. J Cardiothorac Anesth. 1989 Oct;3(5):580–586. doi: 10.1016/0888-6296(89)90156-7. [DOI] [PubMed] [Google Scholar]

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