Cardiopulmonary bypass and renal cell carcinoma with level IV tumour thrombus: can deep hypothermic circulatory arrest limit perioperative mortality?

Abstract : Study Type - Therapy (case series) Level of Evidence 4 OBJECTIVE To review experience with nephrectomy/thrombectomy for a renal cell carcimoma (RCC) with a level IV tumour thrombus and to evaluate the benefit of deep hypothermic circulatory arrest (DHCA) with cardiopulmonary bypass (CPBP). PATIENTS AND METHODS A multi-institutional retrospective database was created to assess the outcomes of surgery for RCC and associated level IV tumour thrombus from 1983 to 2007. Patients were identified based on radiographic records/operative findings. Only cases using CPBP were analysed. Clinicopathological and operative characteristics including use of DHCA were recorded. Overall survival (OS) for all patients and by use of DHCA was assessed. Comparisons of clinical and operative characteristics by use of DHCA were performed. A Cox regression model determined predictors of perioperative/in-hospital mortality. RESULTS In all, 63 patients underwent resection with CPBP; overall perioperative mortality was 22.2%. There were no significant differences in clinicopathological characteristics, operative duration, estimated blood loss, transfusions, and hospital stay by use of DHCA. Perioperative mortality rate was lower in patients undergoing DHCA (8.3% vs 37.5%, P= 0.006). The median OS was longer for the patients undergoing DHCA (15.8 vs 7.7 months); however, this failed to reach statistical significance (P= 0.357). On multivariate analysis, age of >60 years (hazard ratio [HR] 6.7, 95% confidence interval [CI] 1.5-31.1, P= 0.015) and the use of DHCA (HR 0.13, 95% CI 0.036-0.51, P= 0.003) were independent predictors of perioperative mortality. CONCLUSIONS Radical nephrectomy and level IV tumour thrombectomy is associated with significant mortality. The use of DHCA does not appear to adversely affect operative characteristics and may limit perioperative mortality. Further prospective studies should be performed to confirm the benefit of DHCA.
Liste complète des métadonnées

http://www.hal.inserm.fr/inserm-00511237
Contributeur : Hervé De Villemeur <>
Soumis le : mardi 24 août 2010 - 11:41:49
Dernière modification le : mercredi 16 mai 2018 - 11:23:17

Lien texte intégral

Identifiants

Citation

Brian Shuch, Paul Crispen, Bradley Leibovich, Jeff Larochelle, Frédéric Pouliot, et al.. Cardiopulmonary bypass and renal cell carcinoma with level IV tumour thrombus: can deep hypothermic circulatory arrest limit perioperative mortality?. BJU International, Wiley, 2010, 106 (6), pp.879. 〈10.1111/j.1464-410X.2010.09488.x〉. 〈inserm-00511237〉

Partager

Métriques

Consultations de la notice

208