title: Cardiopulmonary bypass and renal cell carcinoma with level IV tumour thrombus: can deep hypothermic circulatory arrest limit perioperative mortality?
abstract: 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).
  
  
  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.
authors.affiliation: Departments of Urology and Biostatistics, University of CaliforniaDepartment of Urology, University of Southern Califormia, Los Angeles, CAMayo Clinic Department of Urology, Rochester, MN, USADepartment of Urology, RennesDepartment of Urology, Nantes, France.
authors.forename: Brian
authors.initials: B
authors.lastname: Shuch
authors.affiliation: Departments of Urology and Biostatistics, University of CaliforniaDepartment of Urology, University of Southern Califormia, Los Angeles, CAMayo Clinic Department of Urology, Rochester, MN, USADepartment of Urology, RennesDepartment of Urology, Nantes, France.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Crispen
authors.affiliation: Departments of Urology and Biostatistics, University of CaliforniaDepartment of Urology, University of Southern Califormia, Los Angeles, CAMayo Clinic Department of Urology, Rochester, MN, USADepartment of Urology, RennesDepartment of Urology, Nantes, France.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Leibovich
authors.affiliation: Departments of Urology and Biostatistics, University of CaliforniaDepartment of Urology, University of Southern Califormia, Los Angeles, CAMayo Clinic Department of Urology, Rochester, MN, USADepartment of Urology, RennesDepartment of Urology, Nantes, France.
authors.forename: Jeff C
authors.initials: JC
authors.lastname: LaRochelle
authors.affiliation: Departments of Urology and Biostatistics, University of CaliforniaDepartment of Urology, University of Southern Califormia, Los Angeles, CAMayo Clinic Department of Urology, Rochester, MN, USADepartment of Urology, RennesDepartment of Urology, Nantes, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Pouliot
authors.affiliation: Departments of Urology and Biostatistics, University of CaliforniaDepartment of Urology, University of Southern Califormia, Los Angeles, CAMayo Clinic Department of Urology, Rochester, MN, USADepartment of Urology, RennesDepartment of Urology, Nantes, France.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Pantuck
authors.affiliation: Departments of Urology and Biostatistics, University of CaliforniaDepartment of Urology, University of Southern Califormia, Los Angeles, CAMayo Clinic Department of Urology, Rochester, MN, USADepartment of Urology, RennesDepartment of Urology, Nantes, France.
authors.forename: Weiqing
authors.initials: W
authors.lastname: Liu
authors.affiliation: Departments of Urology and Biostatistics, University of CaliforniaDepartment of Urology, University of Southern Califormia, Los Angeles, CAMayo Clinic Department of Urology, Rochester, MN, USADepartment of Urology, RennesDepartment of Urology, Nantes, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Crepel
authors.affiliation: Departments of Urology and Biostatistics, University of CaliforniaDepartment of Urology, University of Southern Califormia, Los Angeles, CAMayo Clinic Department of Urology, Rochester, MN, USADepartment of Urology, RennesDepartment of Urology, Nantes, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Schuckman
authors.affiliation: Departments of Urology and Biostatistics, University of CaliforniaDepartment of Urology, University of Southern Califormia, Los Angeles, CAMayo Clinic Department of Urology, Rochester, MN, USADepartment of Urology, RennesDepartment of Urology, Nantes, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Rigaud
authors.affiliation: Departments of Urology and Biostatistics, University of CaliforniaDepartment of Urology, University of Southern Califormia, Los Angeles, CAMayo Clinic Department of Urology, Rochester, MN, USADepartment of Urology, RennesDepartment of Urology, Nantes, France.
authors.forename: Oliver
authors.initials: O
authors.lastname: Bouchot
authors.affiliation: Departments of Urology and Biostatistics, University of CaliforniaDepartment of Urology, University of Southern Califormia, Los Angeles, CAMayo Clinic Department of Urology, Rochester, MN, USADepartment of Urology, RennesDepartment of Urology, Nantes, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Patard
authors.affiliation: Departments of Urology and Biostatistics, University of CaliforniaDepartment of Urology, University of Southern Califormia, Los Angeles, CAMayo Clinic Department of Urology, Rochester, MN, USADepartment of Urology, RennesDepartment of Urology, Nantes, France.
authors.forename: Donald
authors.initials: D
authors.lastname: Skinner
authors.affiliation: Departments of Urology and Biostatistics, University of CaliforniaDepartment of Urology, University of Southern Califormia, Los Angeles, CAMayo Clinic Department of Urology, Rochester, MN, USADepartment of Urology, RennesDepartment of Urology, Nantes, France.
authors.forename: Arie S
authors.initials: AS
authors.lastname: Belldegrun
authors.affiliation: Departments of Urology and Biostatistics, University of CaliforniaDepartment of Urology, University of Southern Califormia, Los Angeles, CAMayo Clinic Department of Urology, Rochester, MN, USADepartment of Urology, RennesDepartment of Urology, Nantes, France.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Blute
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced; D004812:Epidemiologic Methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods / Q000401:mortality*; D019990:Perioperative Care / Q000401:mortality*; D017131:Thrombectomy / Q000379:methods / Q000401:mortality*; D013927:Thrombosis / Q000150:complications / Q000401:mortality / Q000601:surgery*