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Level III-IV Inferior Vena Caval Thrombectomy Without Cardiopulmonary Bypass: Long-Term Experience with Intrapericardial Control

2014; Lippincott Williams & Wilkins; Volume: 192; Issue: 3 Linguagem: Inglês

10.1016/j.juro.2014.03.112

1527-3792

Mukul Patil, Jeremy Montez, Jeffrey Loh-Doyle, Jie Cai, Eila C. Skinner, Anne Schuckman, Duraiyah Thangathurai, Donald G. Skinner, Siamak Daneshmand,

Central Venous Catheters and Hemodialysis

No AccessJournal of UrologyAdult Urology1 Sep 2014Level III-IV Inferior Vena Caval Thrombectomy Without Cardiopulmonary Bypass: Long-Term Experience with Intrapericardial Control Mukul B. Patil, Jeremy Montez, Jeffrey Loh-Doyle, Jie Cai, Eila C. Skinner, Anne Schuckman, Duraiyah Thangathurai, Donald G. Skinner, and Siamak Daneshmand Mukul B. PatilMukul B. Patil Financial interest and/or other relationship with American Medical Systems. More articles by this author , Jeremy MontezJeremy Montez More articles by this author , Jeffrey Loh-DoyleJeffrey Loh-Doyle More articles by this author , Jie CaiJie Cai More articles by this author , Eila C. SkinnerEila C. Skinner More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Duraiyah ThangathuraiDuraiyah Thangathurai More articles by this author , Donald G. SkinnerDonald G. Skinner More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.03.112AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Inferior vena cava tumor thrombectomy requires experienced surgical teams due to complex hemodynamic considerations. The teams often use vascular bypass techniques that introduce additional risk. Inferior vena caval control in the pericardium obviates the need for cardiopulmonary bypass. We reviewed our experience with intrapericardial control during inferior vena caval tumor thrombectomy to evaluate perioperative outcomes and determine factors associated with overall survival. Materials and Methods: We retrospectively reviewed the records of 87 patients who underwent nephrectomy with inferior vena caval tumor thrombectomy using intrapericardial inferior vena caval control from 1978 to 2012. This technique was performed in all 43 and 35 cases of intrahepatic and supradiaphragmatic thrombi, respectively, and in 9 select cases of intra-atrial thrombi. Patient demographics, operative variables and postoperative outcomes were examined. Multivariate regression analysis was used to determine associations between clinical variables and overall survival. Results: Mortality 30 days perioperatively was 9.2% and the incidence of high grade complications was 19.5%. Median survival was 3.1 and 2.5 years in patients with pT3bN0 and pT3cN0, respectively. Extended regional lymphadenectomy, which was performed in all cases, revealed nodal metastasis in 38%. On multivariate analysis ECOG greater than 2 and pT3c stage were associated with worse survival. Histological grade, perinephric fat invasion and lymph node involvement were not associated with worse survival. Conclusions: Intrapericardial control of the inferior vena cava enables a single surgical team to safely perform tumor thrombectomy for intrahepatic and supradiaphragmatic thrombi, eliminating the risk and morbidity related to cardiopulmonary bypass. Although supradiaphragmatic extent and ECOG greater than 2 are associated with worse survival, complete resection with lymphadenectomy can allow for long-term survival in patients with locally advanced disease. References 1 : Contemporary management of renal tumors with venous tumor thrombus. J Urol2010; 184: 833. Link, Google Scholar 2 : Natural history of untreated renal cell carcinoma with venous tumor thrombus. Urol Oncol2013; 31: 1305. Google Scholar 3 : Long-term survival in patients undergoing radical nephrectomy and inferior vena cava thrombectomy: single-center experience. Eur Urol2010; 57: 667. 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Link, Google Scholar © 2014 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byBianchi D (2022) Editorial CommentJournal of Urology, VOL. 209, NO. 1, (109-110), Online publication date: 1-Jan-2023.Huang Q, Zhao G, Chen Y, Wu P, Li S, Peng C, Liu K, Yu H, Gao Y, Xiao C, Fu Q, Shen H, Li Q, Li N, Wang H, Fam X, Wang B, Liu R, Zhang X and Ma X (2022) Robotic Level IV Inferior Vena Cava Thrombectomy Using an Intrapericardial Control Technique: Is It Safe Without Cardiopulmonary Bypass?Journal of Urology, VOL. 209, NO. 1, (99-110), Online publication date: 1-Jan-2023.Gill I, Metcalfe C, Abreu A, Duddalwar V, Chopra S, Cunningham M, Thangathurai D, Ukimura O, Satkunasivam R, Hung A, Papalia R, Aron M, Desai M and Gallucci M (2015) Robotic Level III Inferior Vena Cava Tumor Thrombectomy: Initial SeriesJournal of Urology, VOL. 194, NO. 4, (929-938), Online publication date: 1-Oct-2015.Nguyen H, Tilki D, Dall’Era M, Durbin-Johnson B, Carballido J, Chandrasekar T, Chromecki T, Ciancio G, Daneshmand S, Gontero P, Gonzalez J, Haferkamp A, Hohenfellner M, Huang W, Linares Espinós E, Mandel P, Martinez-Salamanca J, Master V, McKiernan J, Montorsi F, Novara G, Pahernik S, Palou J, Pruthi R, Rodriguez-Faba O, Russo P, Scherr D, Shariat S, Spahn M, Terrone C, Vergho D, Wallen E, Xylinas E, Zigeuner R, Libertino J and Evans C (2015) Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy: Multi-Institutional AnalysisJournal of Urology, VOL. 194, NO. 2, (304-309), Online publication date: 1-Aug-2015. Volume 192 Issue 3 September 2014 Page: 682-689 Supplementary Materials Advertisement Copyright & Permissions© 2014 by American Urological Association Education and Research, Inc.Keywordskidneyvena cavainferiorcarcinomarenal cellthrombosismortalityMetrics Author Information Mukul B. Patil Financial interest and/or other relationship with American Medical Systems. More articles by this author Jeremy Montez More articles by this author Jeffrey Loh-Doyle More articles by this author Jie Cai More articles by this author Eila C. Skinner More articles by this author Anne Schuckman More articles by this author Duraiyah Thangathurai More articles by this author Donald G. Skinner More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF downloadLoading ...