Simplified perfusion strategy for removing retroperitoneal tumors with extensive cavoatrial involvement

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• 作者：Jose L. Navia ; MD^a ; ^{naviaj@ccf.org} ; Nicolas A. Brozzi ; MD^a ; Edward R. Nowicki ; MD ; MS^b ; Eugene H. Blackstone ; MD^a ; ^b ; Venkatesh Krishnamurthi ; MD^c ; Martin G. Sinkewich ; CCP^d ; Jeevanantham Rajeswaran ; MSc^b ; Gregory Pattakos ; MD ; MS^b ; Bruce W. Lytle ; MD^a
• 关键词：18 ; 25
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2012
• 出版时间：May, 2012
• 年：2012
• 卷：143
• 期：5
• 页码：1014-1021
• 全文大小：629 K

文摘

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Objectives

Our objective was to compare effectiveness and safety of a simplified approach for removing retroperitoneal tumors with extensive cavoatrial involvement using beating-heart cardiopulmonary bypass (CPB) versus hypothermic circulatory arrest (HCA).

Methods

From January 1984 to January 2009, 144 patients underwent radical nephrectomy and inferior vena caval tumor thrombectomy, 56 (39 % ) using CPB and 88 (61 % ) HCA. Compared with HCA patients, CPB patients were of similar age (62 ¡À 10 vs 60 ¡À 11 years, P?=?.4) and gender (39 % vs 39 % female, P > .9), with similar stroke history (3.6 % vs 2.3 % , P =.6), but had less pulmonary disease (18 % vs 33 % , P?=?.06) and lower preoperative creatinine concentration (1.3 ¡À 0.72 vs 1.5 ¡À 0.86 mg ¡¤ dL^?1, P?=?.04).

Results

Complete tumor removal was achieved in all patients by both strategies. Compared with HCA procedures, CPB times were shorter (50 ¡À 33 vs 94 ¡À 40 minutes, P?<?.0001). CPB patients required fewer blood transfusions (36 % no transfusion vs 17 % , and 45 % ¡Ý4 units vs 72 % ; P?=?.003) and had no statistical difference in morbidity, including reoperation for bleeding (3.8 % vs 8.0 % , P?=?.3), renal failure requiring dialysis (3.6 % vs 10 % , P?=?.14), respiratory insufficiency (21 % vs 19 % , P?=?.8), sepsis (5.4 % vs 10 % , P?=?.3), stroke (5.4 % vs 1.1 % , P?=?.13), and in-hospital mortality (7.1 % vs 13 % , P?=?.3). Ten-year survival (22 % vs 22 % , P > .9) and freedom from cancer recurrence (24 % vs 28 % , P?=?.8) were similar.

Conclusions

Radical nephrectomy and removal of inferior vena caval tumor-thrombus can be simply, effectively, and safely performed with beating-heart CPB, avoiding the deleterious effects of HCA and providing clinical benefit without increasing morbidity or mortality.