Journal Article

Normothermic cardiopulmonary bypass and beating heart surgery for renal cell cancer with tumor thrombus extension into inferior vena cava and right atrium: a less invasive strategy

Di Benedetto, Roberto, Silvani, Carlo, Carmignani, Luca, Guzzo, Sonia, Nazzani, Sebastiano, Vizziello, Damiano, Baudo, Andrea, Sala, Alessandra, Acquati, Pietro, Finkelberg, Elisabetta, Bortolussi, Giacomo, De Vincentiis, Carlo, Li Puma, Andrea, Bonacina, Edoardo

2024

Overview

Purpose Management of renal cell carcinoma (RCC) with inferior vena cava (IVC) extension is one of the greatest challenges in urology. The gold standard treatment includes extracorporeal circulation and deep hypothermic circulatory arrest (DHCA). However, this surgical treatment has an impact on survival and prognosis. We aim to present a less invasive surgical approach for the treatment of level III and IV IVC thrombi in RCC. Methods We identified all patients undergoing radical nephrectomy and thrombectomy at our Institution between 2016 and 2020. Patients with level IV thrombi were treated with a combined thoracic and abdominal procedure: beating heart surgery with normothermic cardiopulmonary bypass (CPB) was used for thrombus retrieval. Level III thrombi were approached exclusively through an abdominal access. Results We identified 12 patients treated with radical nephrectomy and thrombectomy among 243 patients undergoing radical nephrectomy for RCC. Mean age was 69.3 years, most patients were in T3c clinical stage, without lymph-node involvement (75%) and no metastases (66.7%); 58.3% of patients had Mayo III thrombus classification. Median intensive care unit stay was 2 days and total in-hospital stay 10.5 days. In-hospital mortality was 0%, with a 66.6% survival rate at 2 years. Conclusions Beating heart surgery with normothermic CPB can be considered a less invasive method for radical resection of Mayo level IV IVC thrombi. This surgical approach is safe and feasible, with good in-hospital and short-term outcomes.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Aged / Blood clots / Bypass / Carcinoma, Renal Cell - pathology / Carcinoma, Renal Cell - surgery / Cardiopulmonary Bypass - methods / Female / Heart Atria - pathology / Heart Atria - surgery / Heart rate / Heart surgery / Humans / Invasiveness / Kidney cancer / Kidney Neoplasms - pathology / Kidney Neoplasms - surgery / Male / Medical prognosis / Medicine / Medicine & Public Health / Metastases / Middle Aged / Neoplasm Invasiveness / Neoplastic Cells, Circulating / Nephrectomy / Nephrectomy - methods / Nephrology / Oncology / Patients / Renal cell carcinoma / Retrospective Studies / Thorax / Thrombectomy - methods / Thrombosis / Urology / Vena Cava, Inferior - surgery