Management of Renal Cell Carcinoma with Vena Caval Thrombi via Cardiopulmonary Bypass and Deep Hypothermic Circulatory Arrest

Cavoatrial tumor thrombus: Single-stage surgical approach with profound hypothermia and circulatory arrest, including a review of the literature

“…Since this report, radical tumorectomy with vena caval thrombectomy has become a safe treatment in cases of cavoatrial tumor thrombosis, with operative mortality rates ranging from 2.7% to 13% and an expected 5-year survival ranging from 30% to 72%. [5][6][7][8][9][10][11][12][13] According to Flocks and Robson, 14 in stage III of RCC and adrenal carcinoma, local node involvement is more likely to occur. According to these considerations, Skinner and coworkers 15 and Libertino and associates 3 reported that tumor thrombus, to whatever degree of extension, without metastasized local nodes or perinephric fat involvement has a 5-year survival rate similar to that for a tumor that remains inside the renal capsule.…”

“…5-year survival of 30% to 72%, with an operative mortality of 2.7% to 13% and an immediate palliation of symptoms of obstructive tumors. [5][6][7][8][9][10][11][12][13] The aim of surgical therapy is the radical removal of neoplastic tissue, including the thrombus in the IVC, the adjacent lymphatic structures, and, eventually, the involved caval wall, as well as caval wall reconstruction. There have been several surgical techniques proposed depending on the proximal extension of the tumor thrombus.…”

Clinical Outcomes Related to the Level of Clamping in Inferior Vena Cava Surgery

“…The benefit of CPB lies in improving the immediate control of blood loss. It also enables tumor removal in a bloodless field with circulatory arrest [13]. However, CPB also presents drawbacks such as higher overall blood loss, a greater rate of coagulopathy, and longer operative times.…”

Benefits of Liver Transplantation Surgical Techniques in the Management of Extensive Retroperitoneal Tumors

“…It improves control of immediate blood loss and circulatory arrest allows tumor removal in a bloodless field. However, it is associated with higher overall blood loss, a greater rate of coagulopathy, and longer operative times [7,[12][13][14].…”