Shi-Min Yuan1. 1. Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, 351100, Fujian, People's Republic of China. shiminyuan@126.com.
Abstract
PURPOSE: The present report discusses the indications of cardiopulmonary bypass (CPB) in open nephrectomy and surgical outcomes of conventional and minimally invasive surgical techniques for treating advanced renal cell carcinoma with inferior vena cava tumor thrombus. METHODS: The present study involved a comprehensive retrieval of pertinent literature from the most recent two decades. RESULTS: Comparisons between radical nephrectomy procedures in terms of open, laparoscopic and robotic-assisted surgeries revealed that open surgery had more blood loss, a longer operation time and higher mortality rates than laparoscopic and robotic-assisted surgeries. Furthermore, surgery with CPB was associated with more blood loss than non-CPB surgery. Rates of early and late deaths were much higher in patients with CPB than in those without CPB. CONCLUSIONS: Different surgical techniques had different indications in terms of levels of inferior vena cava tumor thrombus. The laparoscopic, robotic-assisted, open surgical techniques and CPB with deep hypothermic circulatory arrest were indicated for Levels I, II, III and III-IV inferior vena cava tumor thrombus, respectively. Laparoscopic and robotic-assisted surgeries cause less trauma than open surgery but require more complicated equipments to support the procedure. CPB should be avoided in radical nephrectomy whenever possible. The increased application of laparoscopic and robotic techniques in the future is anticipated.
PURPOSE: The present report discusses the indications of cardiopulmonary bypass (CPB) in open nephrectomy and surgical outcomes of conventional and minimally invasive surgical techniques for treating advanced renal cell carcinoma with inferior vena cava tumor thrombus. METHODS: The present study involved a comprehensive retrieval of pertinent literature from the most recent two decades. RESULTS: Comparisons between radical nephrectomy procedures in terms of open, laparoscopic and robotic-assisted surgeries revealed that open surgery had more blood loss, a longer operation time and higher mortality rates than laparoscopic and robotic-assisted surgeries. Furthermore, surgery with CPB was associated with more blood loss than non-CPB surgery. Rates of early and late deaths were much higher in patients with CPB than in those without CPB. CONCLUSIONS: Different surgical techniques had different indications in terms of levels of inferior vena cava tumor thrombus. The laparoscopic, robotic-assisted, open surgical techniques and CPB with deep hypothermic circulatory arrest were indicated for Levels I, II, III and III-IV inferior vena cava tumor thrombus, respectively. Laparoscopic and robotic-assisted surgeries cause less trauma than open surgery but require more complicated equipments to support the procedure. CPB should be avoided in radical nephrectomy whenever possible. The increased application of laparoscopic and robotic techniques in the future is anticipated.
Authors: Philip P Goodney; Dale Tavris; F Lee Lucas; Thomas Gross; Elliott S Fisher; Samuel R G Finlayson Journal: J Vasc Surg Date: 2010-04-10 Impact factor: 4.268
Authors: Axel Haferkamp; Patrick J Bastian; Hildegard Jakobi; Maria Pritsch; Jesco Pfitzenmaier; Peter Albers; Peter Hallscheidt; Stefan C Müller; Markus Hohenfellner Journal: J Urol Date: 2007-05 Impact factor: 7.450
Authors: Amnon Zisman; Jeff A Wieder; Allan J Pantuck; Debby H Chao; Frederick Dorey; Jonathan W Said; Barbara J Gitlitz; Jean B deKernion; Robert A Figlin; Arie S Belldegrun Journal: J Urol Date: 2003-03 Impact factor: 7.450
Authors: Bruno Chiappini; Carlo Savini; Giuseppe Marinelli; Sofia Martin Suarez; Marco Di Eusanio; Vinicio Fiorani; Angelo Pierangeli Journal: J Thorac Cardiovasc Surg Date: 2002-10 Impact factor: 5.209
Authors: Gaetano Ciancio; Samir P Shirodkar; Mark S Soloway; Alan S Livingstone; Michael Barron; Tomas A Salerno Journal: Ann Thorac Surg Date: 2010-02 Impact factor: 4.330