OBJECTIVES: To describe the technique, complications, and outcomes of vascular bypass during radical nephrectomy and tumor thrombectomy for patients with renal cell carcinoma and venous tumor thrombus. The indications and results for venovenous bypass (VVB) versus cardiopulmonary bypass (CPB) were reviewed as well. METHODS: We identified 41 patients who had undergone radical nephrectomy and thrombectomy requiring VVB (n = 13) or CPB (n = 28) at our institution from 1970 to 2005 for renal cell carcinoma with venous tumor thrombus. The clinicopathologic variables and complication rates were compared between the VVB and CPB patients. The postoperative cancer-specific survival was estimated using the Kaplan-Meier method and compared using the log-rank test. RESULTS: The patients undergoing VVB experienced significantly shorter median bypass times (P = 0.015), operative times (P <0.001), and anesthesia times (P <0.001) compared with those treated with CPB. In addition, VVB was associated with trends toward decreased median intraoperative blood loss (1200 mL versus 2725 mL, P = 0.336), decreased blood/blood products transfused (median 2300 mL versus 4275 mL, P = 0.256), and decreased length of hospitalization (median 7 days versus 9 days, P = 0.078). The 5-year cancer-specific survival rate was not significantly different for patients undergoing VVB (29.8%) versus those treated with CPB (36.4%; P = 0.989). CONCLUSIONS: VVB was associated with significantly shorter bypass, operative, and anesthesia times, as well as trends toward decreased blood loss and hospital stay. Although the choice of bypass technique must be individualized according to the assessment of the bulk of thrombus to be resected, our results support the continued use of VVB in the management of renal cell carcinoma with extensive venous tumor thrombus, when appropriate.
OBJECTIVES: To describe the technique, complications, and outcomes of vascular bypass during radical nephrectomy and tumor thrombectomy for patients with renal cell carcinoma and venous tumor thrombus. The indications and results for venovenous bypass (VVB) versus cardiopulmonary bypass (CPB) were reviewed as well. METHODS: We identified 41 patients who had undergone radical nephrectomy and thrombectomy requiring VVB (n = 13) or CPB (n = 28) at our institution from 1970 to 2005 for renal cell carcinoma with venous tumor thrombus. The clinicopathologic variables and complication rates were compared between the VVB and CPB patients. The postoperative cancer-specific survival was estimated using the Kaplan-Meier method and compared using the log-rank test. RESULTS: The patients undergoing VVB experienced significantly shorter median bypass times (P = 0.015), operative times (P <0.001), and anesthesia times (P <0.001) compared with those treated with CPB. In addition, VVB was associated with trends toward decreased median intraoperative blood loss (1200 mL versus 2725 mL, P = 0.336), decreased blood/blood products transfused (median 2300 mL versus 4275 mL, P = 0.256), and decreased length of hospitalization (median 7 days versus 9 days, P = 0.078). The 5-year cancer-specific survival rate was not significantly different for patients undergoing VVB (29.8%) versus those treated with CPB (36.4%; P = 0.989). CONCLUSIONS: VVB was associated with significantly shorter bypass, operative, and anesthesia times, as well as trends toward decreased blood loss and hospital stay. Although the choice of bypass technique must be individualized according to the assessment of the bulk of thrombus to be resected, our results support the continued use of VVB in the management of renal cell carcinoma with extensive venous tumor thrombus, when appropriate.
Authors: Gianpaolo Carrafiello; Gianlorenzo Dionigi; Luigi Boni; Monica Mangini; Anna Maria Ierardi; Filippo Piacentino; Annalisa Di Massa; Larissa Nocchi Cardim; Antonio Biondi; Carlo Fugazzola Journal: Updates Surg Date: 2011-11-08
Authors: Ricardo A Rendon; Anil Kapoor; Rodney Breau; Michael Leveridge; Andrew Feifer; Peter C Black; Alan So Journal: Can Urol Assoc J Date: 2014-05 Impact factor: 1.862
Authors: Hao G Nguyen; Derya Tilki; Marc A Dall'Era; Blythe Durbin-Johnson; Joaquín A Carballido; Thenappan Chandrasekar; Thomas Chromecki; Gaetano Ciancio; Siamak Daneshmand; Paolo Gontero; Javier Gonzalez; Axel Haferkamp; Markus Hohenfellner; William C Huang; Estefania Linares Espinós; Philipp Mandel; Juan I Martinez-Salamanca; Viraj A Master; James M McKiernan; Francesco Montorsi; Giacomo Novara; Sascha Pahernik; Juan Palou; Raj S Pruthi; Oscar Rodriguez-Faba; Paul Russo; Douglas S Scherr; Shahrokh F Shariat; Martin Spahn; Carlo Terrone; Daniel Vergho; Eric M Wallen; Evanguelos Xylinas; Richard Zigeuner; John A Libertino; Christopher P Evans Journal: J Urol Date: 2015-03-19 Impact factor: 7.450