Background

Radical nephrectomy (RN) and caval thrombectomy (CT) for renal cell carcinoma, with extracorporeal circulation (ECC) and deep hypothermic circulatory arrest (DHCA) is a challenging surgical approach.

Objective

To assess peri-operative and oncologic outcomes of renal cell carcinoma patients treated with RN and CT, using ECC and DHCA.

Design, setting, and participants

We retrospectively evaluated 46 patients who underwent RN and CT using ECC and DHCA.

Surgical procedure

After retroperitoneal nodal dissection and RN, a cardiopulmonary bypass was placed and DHCA achieved. A combined approach through the abdomen and the thorax was described.

Measurements

Perioperative and long-term survival outcomes were reported.

Results and limitations

Median operative time and length of hospital stay were 545 min and 22 d. Overall, 33 patients (72%) did not require any additional interventional or surgical treatment. Thirty-day and 90-d mortality were 11% (5/46) and 15% (7/46). The 1-yr, 2-yr, and 3-yr cancer specific mortality (CSM)-free survival rates were 77%, 62%, and 56%, respectively. After stratification, according to metastatic status at diagnosis, CSM-free survival rates were significantly lower for cM1 patients compared with cM0 patients (1-yr 46% vs 93%, 2-yr 23% vs 81%, 3-yr 23% vs 73%, p < 0.01). Our study is limited by its retrospective and uncomparative nature.

Conclusions

RN with CT using ECC and DHCA is a challenging procedure which requires a dedicated multidisciplinary working team to minimise complications and maximise patients’ outcomes.

Patient summary

Patients with kidney cancer and a thrombus within the inferior vena cava, which reaches above the diaphragm, can be treated with surgery. However, this kind of surgical treatment is challenging and requires a dedicated multidisciplinary team in order to accomplish the task.

中文翻译：

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使用体外循环和深低温热循环阻滞治疗侵犯trium上下腔静脉和/或右心房的肾细胞癌的肾切除术和caval血栓切除术的围手术期和肿瘤学结果

背景

肾细胞癌的根治性肾切除术（RN）和腔静脉血栓切除术（CT）以及体外循环（ECC）和深低温热循环停止（DHCA）是一项具有挑战性的手术方法。

客观的

为了评估使用RN和CT治疗的肾细胞癌患者的围手术期和肿瘤学结局，使用ECC和DHCA。

设计，设置和参与者

我们回顾性评估了使用ECC和DHCA接受RN和CT手术的46例患者。

手术程序

腹膜后淋巴结清扫和RN后，进行体外循环并获得DHCA。描述了通过腹部和胸部的组合方法。

测量

据报道围手术期和长期生存的结果。

结果与局限性

中位手术时间和住院时间为545分钟和22天。总体而言，有33例患者（占72％）不需要任何其他干预或手术治疗。30天和90天死亡率分别为11％（5/46）和15％（7/46）。无1年，2年和3年的无癌症特定死亡率（CSM）的存活率分别为77％，62％和56％。分层后，根据诊断时的转移状态，cM1患者的无CSM生存率显着低于cM0患者（1年46％vs 93％，2年23％vs 81％，3年23％vs 73％，p  <0.01）。我们的研究受到回顾性和非比较性的限制。

结论

使用ECC和DHCA进行CT的RN手术具有挑战性，需要一个专业的多学科工作团队来尽量减少并发症并最大化患者的预后。

病人总结

患有肾癌和下腔静脉内血栓达到横diaphragm膜上方的患者可以接受手术治疗。然而，这种手术治疗具有挑战性，并且需要专门的多学科团队来完成任务。