Radical Nephrocapsulectomy and Caval Thrombectomy with Extracorporeal Circulation and Deep Hypothermic Circulatory Arrest in Right Anterior Minithoracotomy: A Minimally Invasive Approach

Bertini, Roberto; Roscigno, Marco; Lapenna, Elisabetta; Pasta, A.; Petralia, Giovanni; Strada, E.; Naspro, Richard; Pozzo, L. Da; Colombo, Renzo; Rigatti, Patrìzio

doi:10.1016/j.urology.2007.11.122

Cited by 11 publications

(7 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Medical therapies have proven ineffective in the treatment of RCC with IVC thrombosis, and radical nephrectomy together with thrombectomy is the only effective therapeutic alternative for these patients [ 9 , 13 ]. Surgical management of RCC in which there is extension into the renal vein, IVC, or even the right atrium, however, poses a significant technical challenge [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, some authors agree that the RCC-associated tumor thrombus does not translate to a specific prognostic significance if it can be treated successfully with surgery [ 5 ]. To manage cases of RCC with IVC thrombus, several different surgical approaches such as liver transplantation [ 6 , 7 ] and thrombectomy using cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) [ 8 , 9 ] have been described. New developments in imaging, anesthesiology, and perioperative care have allowed for most thrombi to be removed successfully.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of renal cell carcinoma with a level III or level IV inferior vena cava thrombus using cardiopulmonary bypass and deep hypothermic circulatory arrest

Chen

et al. 2015

World J Surg Onc

View full text Add to dashboard Cite

BackgroundThe aim of this study was to investigate the minimally invasive cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) approach in the management of renal cell carcinoma (RCC) with level III or IV inferior vena cava (IVC) thrombus and evaluate the survival outcomes.MethodsWe performed a retrospective analysis on 32 RCC patients with IVC thrombus that underwent nephrectomy and thrombectomy via the minimally invasive CPB/DHCA approach between January 2007 and December 2013. Perioperative variables (for example, operative time, CPB duration, and circulatory arrest duration), estimated blood loss, hospital stay, perioperative complications, and survival data were recorded and analyzed.ResultsThirty-two patients (median age: 56 years) were treated surgically using the CPB and DHCA approach for RCC with a level III (n = 25) or level IV (n = 7) tumor thrombus. The median operation time was 360 min (interquartile range (IQR): 300 to 435 min) with median CPB and DHCA durations of 149 min and 23 min, respectively. The median estimated blood loss was 2,500 ml. Four complications were observed but no deaths occurred perioperatively. The median follow-up was 25 months (range: 4 to 64 months). The mean overall survival (OS) was 28.2 ± 4.6 months while the disease-free survival (DFS) was 19.5 ± 11.6 months. In patients with M0 disease, ten patients developed metastases and were treated with sorafenib as an adjuvant therapy. The mean OS and DFS of this subgroup were 25.4 ± 12.8 months and 16.0 ± 14.2 months, respectively.ConclusionsRadical nephrectomy and thrombectomy using CPB and DHCA to treat RCC is a relatively safe approach associated with low morbidity and mortality. This minimally invasive procedure may help minimize surgical trauma and improve perioperative outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of renal cell carcinoma with a level III or level IV inferior vena cava thrombus using cardiopulmonary bypass and deep hypothermic circulatory arrest

Chen

et al. 2015

World J Surg Onc

View full text Add to dashboard Cite

show abstract

“…The median survival of the patients with papillary subtype was 5.2 months when those patients were positive for node or distant metastases. In general, node or distant metastases have been reported to be predictive factors for the poor prognosis . In addition, this extensive surgery is associated with a high mortality or morbidity rate.…”

Section: Discussionmentioning

confidence: 99%

“…In general, node or distant metastases have been reported to be predictive factors for the poor prognosis. 6,9,27,28 In addition, this extensive surgery is associated with a high mortality or morbidity rate. Early morbidity was reported as approximately 50%, and perioperative mortality is between 3.1 and 8%.…”

Section: Discussionmentioning

confidence: 99%

Negative impact of papillary histological subtype in patients with renal cell carcinoma extending into the inferior vena cava: Single‐center experience

et al. 2013

View full text Add to dashboard Cite

Abbreviations & Acronyms Ca = calcium cN+ = clinical node metastases CRP = C-reactive protein CSS = cancer-specific survival ECOG-PS = Eastern Cooperative Oncology Group Performance Status Scale Hb = hemoglobin IVC = inferior vena cava LDH = lactate dehydrogenase NUL = normal upper limit pN+ = pathological node metastases PS = performance status pT = pathological T RCC = renal cell carcinoma RCC-IVC = renal cell carcinoma extending into the inferior vena cava Objectives: To investigate the impact of histological subtypes on the survival of patients presenting with renal cell carcinoma extending into the inferior vena cava. Methods: From January 1985 until October 2011, 68 patients with renal cell carcinoma extending into the inferior vena cava underwent radical nephrectomy and inferior vena cava thrombectomy at Tokyo Women's Medical University, Tokyo, Japan. Their clinical and pathological parameters were reviewed from the medical charts. Results: The median follow up was 19 months (range 0.1-144 months). The tumor thrombus level was I in four patients (6%), II in 38 patients (56%), III in 12 patients (18%) and IV in 14 patients (20%). Papillary histological subtype was found in seven patients (10%), and clear cell in 61 patients (90%). Patients with a papillary subtype had a significantly worse survival outcome than the patients with the clear cell subtype (median survival time 9.0 vs 36.1 months, P < 0.001). Multivariate analysis also showed that the papillary subtype was the only independent prognostic factor for unfavorable cancer-specific survival (P = 0.03). When the patients presented with metastases to lymph nodes or distant metastases, the median survival of the patients with a papillary subtype was extremely short, at just 5.2 months compared with those with a clear cell subtype (24.0 months, P = 0.001). Conclusions: Patients with renal cell carcinoma extending into the inferior vena cava with a papillary subtype show a considerably shorter survival compared with those with a clear cell subtype. The papillary renal cell carcinoma extending into the inferior vena cava patient might be an inappropriate candidate for extensive surgery when metastases to nodes or distant organs are found.

show abstract

“…The use of mild hypothermia with intermittent crossclamping of the abdominal aorta [44], the description of a minimal access to the cardiac cavity through a right anterior minithoracotomy [45], and the use of antegrade cerebral and cardiac perfusion during DHCA [46] confirm the recent efforts made to reduce these potential complications.…”

Section: Cardiopulmonary Bypass and Deep Hypothermic Circulatory Arrestmentioning

confidence: 85%

Update on Surgical Management of Renal Cell Carcinoma with Venous Extension

González

2011

Curr Urol Rep

View full text Add to dashboard Cite

Intravenous extension of renal cell carcinoma remains one of the most intense debate topics in urologic oncology. In the absence of effective alternative treatment, complete surgical removal of the primary tumor with its extension along the vena cava is the only hope for a potential cure. For this reason, an aggressive approach has been established as the mainstay of treatment. Recent advances in the understanding of the biology of intravascular tumor invasion and the considerable progress in the fields of diagnosis and treatment of this entity, with innovative surgical and systemic strategies, have completely redefined the management of these patients. A PubMed-MEDLINE search was conducted to identify relevant articles on the preoperative assessment and surgical management of renal cell carcinoma with intravenous tumor extension to provide updated knowledge on this always challenging topic.

show abstract

Radical Nephrocapsulectomy and Caval Thrombectomy with Extracorporeal Circulation and Deep Hypothermic Circulatory Arrest in Right Anterior Minithoracotomy: A Minimally Invasive Approach

Cited by 11 publications

References 25 publications

Treatment of renal cell carcinoma with a level III or level IV inferior vena cava thrombus using cardiopulmonary bypass and deep hypothermic circulatory arrest

Treatment of renal cell carcinoma with a level III or level IV inferior vena cava thrombus using cardiopulmonary bypass and deep hypothermic circulatory arrest

Negative impact of papillary histological subtype in patients with renal cell carcinoma extending into the inferior vena cava: Single‐center experience

Update on Surgical Management of Renal Cell Carcinoma with Venous Extension

Contact Info

Product

Resources

About