title: Simplified perfusion strategy for removing retroperitoneal tumors with extensive cavoatrial involvement.
abstract: OBJECTIVE
  Our objective was to compare effectiveness and safety of a simplified approach for removing retroperitoneal tumors with extensive cavoatrial involvement using beating-heart cardiopulmonary bypass (CPB) versus hypothermic circulatory arrest (HCA).
  
  
  METHODS
  From January 1984 to January 2009, 144 patients underwent radical nephrectomy and inferior vena caval tumor thrombectomy, 56 (39%) using CPB and 88 (61%) HCA. Compared with HCA patients, CPB patients were of similar age (62 ± 10 vs 60 ± 11 years, P = .4) and gender (39% vs 39% female, P > .9), with similar stroke history (3.6% vs 2.3%, P =.6), but had less pulmonary disease (18% vs 33%, P = .06) and lower preoperative creatinine concentration (1.3 ± 0.72 vs 1.5 ± 0.86 mg · dL(-1), P = .04).
  
  
  RESULTS
  Complete tumor removal was achieved in all patients by both strategies. Compared with HCA procedures, CPB times were shorter (50 ± 33 vs 94 ± 40 minutes, P < .0001). CPB patients required fewer blood transfusions (36% no transfusion vs 17%, and 45% ≥4 units vs 72%; P = .003) and had no statistical difference in morbidity, including reoperation for bleeding (3.8% vs 8.0%, P = .3), renal failure requiring dialysis (3.6% vs 10%, P = .14), respiratory insufficiency (21% vs 19%, P = .8), sepsis (5.4% vs 10%, P = .3), stroke (5.4% vs 1.1%, P = .13), and in-hospital mortality (7.1% vs 13%, P = .3). Ten-year survival (22% vs 22%, P > .9) and freedom from cancer recurrence (24% vs 28%, P = .8) were similar.
  
  
  CONCLUSIONS
  Radical nephrectomy and removal of inferior vena caval tumor-thrombus can be simply, effectively, and safely performed with beating-heart CPB, avoiding the deleterious effects of HCA and providing clinical benefit without increasing morbidity or mortality.
authors.affiliation: Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA. naviaj@ccf.org
authors.forename: Jose L
authors.initials: JL
authors.lastname: Navia
authors.forename: Nicolas A
authors.initials: NA
authors.lastname: Brozzi
authors.forename: Edward R
authors.initials: ER
authors.lastname: Nowicki
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Krishnamurthi
authors.forename: Martin G
authors.initials: MG
authors.lastname: Sinkewich
authors.forename: Jeevanantham
authors.initials: J
authors.lastname: Rajeswaran
authors.forename: Gregory
authors.initials: G
authors.lastname: Pattakos
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Lytle
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009392:Nephrectomy / Q000009:adverse effects / Q000401:mortality; D009820:Ohio; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D017131:Thrombectomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*