Surgical management of retroperitoneal tumors with vena caval thrombus in the inferior cava using cardiopulmonary bypass, arrested circulation and profound hypothermia.
OBJECTIVE
It was our aim to review our surgical experience with retroperitoneal tumors extending to the vena cava by using cardiopulmonary bypass, deep hypothermia and circulatory arrest.


METHODS
We performed this procedure in 15 patients. The ages ranged between 16 and 70 years. The primary malignancies were renal cell carcinoma (n = 13), Wilms' tumor (n = 1) and paratesticular rhabdomyosarcoma (n = 1).


RESULTS
There were no operative deaths. One patient died on the fourth postoperative day because of pulmonary embolization. The most common postoperative complications were: 1 patient required surgical reexploration because of hemorrhage, there was transitory renal failure in 3 patients, 1 patient developed a postoperative reactive psychosis and 1 patient developed a subclinical pericarditis.


CONCLUSIONS
We believe that the resection of retroperitoneal malignancies with venous tumor thrombus extension offers, in selected patients, the only chance of reasonable long-term survival. The application of a cardiopulmonary bypass and hypothermia in high level vena cava thrombi is an important advance that has improved the safety and technical efficacy of a difficult surgical undertaking.
Rodríguez-Rubio
F I
FI
Department of Urology, Clinica Universitaria, Faculty of Medicine, University of Navarra, Pamplona, Spain.
Abad
J I
JI
Sanz
G
G
Diez-Caballero
F
F
Martín-Marquina
A
A
Rosell
D
D
Robles
J E
JE
Zudaire
J J
JJ
Llorens
R
R
Berián
J M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D006324:Heart Arrest, Induced; D006801:Humans; D007036:Hypothermia, Induced; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D011183:Postoperative Complications; D012186:Retroperitoneal Neoplasms / Q000473:pathology / Q000601:surgery*; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery; D014682:Vena Cava, Inferior / Q000473:pathology*