Contemporary techniques and safety of cardiovascular procedures in the surgical management of renal cell carcinoma with tumor thrombus

Lubahn, Jordon G.; Sagalowsky, Arthur I.; Rosenbaum, David; Di̇kmen, Erkan; Bhojani, Rehal A.; Paul, Michelle C.; Dolmatch, Bart L.; Josephs, Shellie C.; Benaim, Elie A.; Levinson, Barry S.; Wait, Michael A.; Ring, W. Steves; DiMaio, J. Michael

doi:10.1016/j.jtcvs.2006.01.038

Cited by 30 publications

(18 citation statements)

References 25 publications

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“…The cardiothoracic surgeon is increasingly involved [19,37] were previously excluded from their management [10,16,51]. We believe that preemptive cardiothoracic consultation is instrumental in developing such standard of care.…”

Section: Discussionmentioning

confidence: 99%

Tumour Thrombi in the Suprahepatic Inferior Vena Cava: The Cardiothoracic Surgeons’ View

Protopapas

Ashrafian

Athanasiou

2013

ISRN Vascular Medicine

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Background. Retroperitoneal tumours propagate intrathoracic caval tumour thrombi (ICTT) of which we consider two subgroups: ICTT-III (extracardiac) and ICTT-IV (intracardiac). Methods. Case series review. Results. 29 series with 784 patients, 453 with extracardiac and 331 with intracardiac ICTT. Average age was 59 years. 98% of the tumours were RCC, 1% adrenal and Wilms' tumours, and 1% transitional cell carcinomas. The prevalent incision was rooftop with or without sternotomy. Mortality was 10% (5% for ICTT-III, 15% for ICTT-IV). Morbidity was 56% (36% for ICTT-III, 64% for ICTT-IV) and reoperation for bleeding was the commonest complication (14%). Mean Blood loss was 2.6 litres for ICTT-III and 3.7 litres for ICTT-IV. Mean blood product use was 2.4 litres for ICTT-III and 3.5 litres for ICTT-IV. Operative and anaesthetic times exceeded 5 hours. Hospital stay averaged 13 days. Variations in perioperative care included preoperative embolisation, perioperative transoesophageal echo, surgical incisions, and extracorporeal circulation. Brief Summary. Surgery for ICTT has high transfusion, operating/anaesthetic time, and in-hospital stay requirements, and intracardiac ICTT also attract higher risk. Preoperative tumour embolisation is controversial. The cardiothoracic team offers proactive optimisation of blood loss and preemptive management of intracardiac thrombus impaction: we should always be involved in the management the ICTT.

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Section: Discussionmentioning

confidence: 99%

Tumour Thrombi in the Suprahepatic Inferior Vena Cava: The Cardiothoracic Surgeons’ View

Protopapas

Ashrafian

Athanasiou

2013

ISRN Vascular Medicine

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“…The surgical approach should not compromise the oncologic goals of the operation — it has been shown that even in the case of tumor thrombus, full surgical excision of RCC and the thrombus results in acceptable long-term survival, even when compared with patients without IVC tumor thrombus. [1314] However, the presence of BCS sharply increases the complexity of the surgery. Primarily, some patients may have a coagulopathy related to a diminished hepatic function that interferes with appropriate clotting, increasing the risk of intra- and postoperative bleeding.…”

Section: Discussionmentioning

confidence: 99%

Budd-Chiari syndrome in urology: Impact on nephrectomy for advanced renal cell carcinoma

2011

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Objectives:Budd-Chiari syndrome (BCS) is a poorly understood entity in urology. It results from obstruction of the hepatic veins and the subsequent complications. It has been infrequently reported to be secondary to hepatic venous obstruction from invasion by an inferior vena cava (IVC) tumor thrombus in renal cell carcinoma (RCC). We report the largest known series of patients with RCC and BCS.Patients and Methods:Ten patients presented to a tertiary hospital with locally advanced RCC with IVC tumor thrombus. All were evaluated and had clinical or radiographic evidence of BCS. All underwent nephrectomy, IVC thrombectomy or ligation, and tumor removal from the hepatic veins. The perioperative and pathological factors were measured. These included estimated blood loss (EBL) and transfusions. Inpatient factors including duration of intubation, length of intensive care unit (ICU) stay, and overall length of stay (LOS) were recorded. The tumor-free status was evaluated.Results:The average age was 59 years. No intraoperative deaths occurred. Two intraoperative complications were noted. The mean EBL was 4244 cc; mean surgery length was 8 hours 12 minutes; and the mean ICU stay was nine days. The overall LOS averaged 13.25 days. One patient died postoperatively of sepsis and multisystem organ failure. One patient required reoperation for an abdominal wall hematoma caused by subcutaneous enoxaparin administration. Average follow-up was 28 months. Five patients are alive with no evidence of disease.Conclusions:Budd-Chiari syndrome is a rare entity in urology, with a potential for significant morbidity and mortality. Surgical excision of the primary tumor along with thrombectomy results in alleviation of BCS and improvement in the patient.

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“…According to Lubahn et al [6] approximately 50% of the patients with renal tumors involving the IVC, warrant cardiothoracic involvement. Furthermore the overall incidence of extensive IVC disease involving the right atrium according to Bissada et al [5] & Hermanek et al [7] is around 27.7%.…”

Section: Discussionmentioning

confidence: 99%

“…Generally for level III disease some institutions [9] favor cavotomy without the use of CPB [10] or with the use of venous-venous bypass [11,6]. The latter group in a large series of patients concluded that the need for invasive cardiovascular procedures increased the risk of perioperative complications.…”

Section: Discussionmentioning

confidence: 99%

Surgical resection of a renal cell carcinoma involving the inferior vena cava: the role of the cardiothoracic surgeon

Parissis

Akbar

Tolan

et al. 2010

J Cardiothorac Surg

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BackgroundThe techniques for the resection of renal tumors with IVC extension are based on the experience of individual units. We attempt to provide a logical approach of the surgical strategies in a stepwise fashion.MethodsOver 6-years 9 patients with renal cell carcinoma invading the IVC, underwent surgery. There were 6 males. The extension was at level IV in 4 and III in 5 cases. CPB used in 8 and hypothermia and circulatory arrest in all patients with level IV disease. The results and an algorithm of the plan of action, as per level of extension are presented.ResultsPlan of action: For level I-II disease: No Cardiothoracic involvement, For level III: Cardiopulmonary Bypass (CPB) & control of the cavo-atrial junction. For level IV: use of brief periods of Circulatory Arrest & repair of the Cavotomy with a pericardial patch. Postoperative morbidity: prolonged ICU stay, 3 patients (33.3%); tracheostomy, 1 (11.1%); Sepsis, 2 (22.2%); CVA 1, (11.1%). Mortality: 2 patients (22.2%)ConclusionsTotal clearance of the IVC from an adherent tumor is important, therefore extensive level IV disease presents a surgical challenge.We recommend CPB for level III and brief periods of Total Circulatory Arrest (TCA) for level IV disease.

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Contemporary techniques and safety of cardiovascular procedures in the surgical management of renal cell carcinoma with tumor thrombus

Cited by 30 publications

References 25 publications

Tumour Thrombi in the Suprahepatic Inferior Vena Cava: The Cardiothoracic Surgeons’ View

Tumour Thrombi in the Suprahepatic Inferior Vena Cava: The Cardiothoracic Surgeons’ View

Budd-Chiari syndrome in urology: Impact on nephrectomy for advanced renal cell carcinoma

Surgical resection of a renal cell carcinoma involving the inferior vena cava: the role of the cardiothoracic surgeon

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