Alessandro Nini1, Umberto Capitanio1, Alessandro Larcher1, Paolo Dell'Oglio1, Federico Dehò1, Nazareno Suardi1, Fabio Muttin1, Cristina Carenzi2, Massimo Freschi3, Roberta Lucianò3, Giovanni La Croce1, Alberto Briganti1, Renzo Colombo1, Andrea Salonia1, Alessandro Castiglioni4, Patrizio Rigatti2, Francesco Montorsi1, Roberto Bertini5. 1. Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Division of Oncology, URI, Urological Research Institute, Renal cancer Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. 2. Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy. 3. Unit of Pathology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy. 4. Unit of Cardiac Surgery, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy. 5. Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Division of Oncology, URI, Urological Research Institute, Renal cancer Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy. Electronic address: bertini.roberto@hsr.it.
Abstract
BACKGROUND: Radical nephrectomy (RN) and caval thrombectomy (CT) for renal cell carcinoma, with extracorporeal circulation (ECC) and deep hypothermic circulatory arrest (DHCA) is a challenging surgical approach. OBJECTIVE: To assess peri-operative and oncologic outcomes of renal cell carcinoma patients treated with RN and CT, using ECC and DHCA. DESIGN, SETTING, AND PARTICIPANTS: We retrospectively evaluated 46 patients who underwent RN and CT using ECC and DHCA. SURGICAL PROCEDURE: After retroperitoneal nodal dissection and RN, a cardiopulmonary bypass was placed and DHCA achieved. A combined approach through the abdomen and the thorax was described. MEASUREMENTS: Perioperative and long-term survival outcomes were reported. RESULTS AND LIMITATIONS: Median operative time and length of hospital stay were 545min and 22 d. Overall, 33 patients (72%) did not require any additional interventional or surgical treatment. Thirty-day and 90-d mortality were 11% (5/46) and 15% (7/46). The 1-yr, 2-yr, and 3-yr cancer specific mortality (CSM)-free survival rates were 77%, 62%, and 56%, respectively. After stratification, according to metastatic status at diagnosis, CSM-free survival rates were significantly lower for cM1 patients compared with cM0 patients (1-yr 46% vs 93%, 2-yr 23% vs 81%, 3-yr 23% vs 73%, p<0.01). Our study is limited by its retrospective and uncomparative nature. CONCLUSIONS: RN with CT using ECC and DHCA is a challenging procedure which requires a dedicated multidisciplinary working team to minimise complications and maximise patients' outcomes. PATIENT SUMMARY: Patients with kidney cancer and a thrombus within the inferior vena cava, which reaches above the diaphragm, can be treated with surgery. However, this kind of surgical treatment is challenging and requires a dedicated multidisciplinary team in order to accomplish the task.
BACKGROUND: Radical nephrectomy (RN) and caval thrombectomy (CT) for renal cell carcinoma, with extracorporeal circulation (ECC) and deep hypothermic circulatory arrest (DHCA) is a challenging surgical approach. OBJECTIVE: To assess peri-operative and oncologic outcomes of renal cell carcinomapatients treated with RN and CT, using ECC and DHCA. DESIGN, SETTING, AND PARTICIPANTS: We retrospectively evaluated 46 patients who underwent RN and CT using ECC and DHCA. SURGICAL PROCEDURE: After retroperitoneal nodal dissection and RN, a cardiopulmonary bypass was placed and DHCA achieved. A combined approach through the abdomen and the thorax was described. MEASUREMENTS: Perioperative and long-term survival outcomes were reported. RESULTS AND LIMITATIONS: Median operative time and length of hospital stay were 545min and 22 d. Overall, 33 patients (72%) did not require any additional interventional or surgical treatment. Thirty-day and 90-d mortality were 11% (5/46) and 15% (7/46). The 1-yr, 2-yr, and 3-yr cancer specific mortality (CSM)-free survival rates were 77%, 62%, and 56%, respectively. After stratification, according to metastatic status at diagnosis, CSM-free survival rates were significantly lower for cM1 patients compared with cM0 patients (1-yr 46% vs 93%, 2-yr 23% vs 81%, 3-yr 23% vs 73%, p<0.01). Our study is limited by its retrospective and uncomparative nature. CONCLUSIONS: RN with CT using ECC and DHCA is a challenging procedure which requires a dedicated multidisciplinary working team to minimise complications and maximise patients' outcomes. PATIENT SUMMARY:Patients with kidney cancer and a thrombus within the inferior vena cava, which reaches above the diaphragm, can be treated with surgery. However, this kind of surgical treatment is challenging and requires a dedicated multidisciplinary team in order to accomplish the task.
Authors: Marco Bandini; Michele Marchioni; Felix Preisser; Sebastiano Nazzani; Zhe Tian; Markus Graefen; Francesco Montorsi; Fred Saad; Shahrokh F Shariat; Luigi Schips; Alberto Briganti; Pierre I Karakiewicz Journal: Can Urol Assoc J Date: 2019-09-27 Impact factor: 1.862
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Authors: Benedikt Hoeh; Rocco Simone Flammia; Lukas Hohenhorst; Gabriele Sorce; Andrea Panunzio; Stefano Tappero; Zhe Tian; Fred Saad; Michele Gallucci; Alberto Briganti; Carlo Terrone; Shahrokh F Shariat; Markus Graefen; Derya Tilki; Alessandro Antonelli; Marina Kosiba; Philipp Mandel; Luis A Kluth; Andreas Becker; Felix K H Chun; Pierre I Karakiewicz Journal: Eur Urol Open Sci Date: 2022-08-30