title: Deep hypothermia and low flow for surgery for abdominal or extraperitoneal tumors with cavoatrial extension.
abstract: BACKGROUND
  Surgical treatment of retroperitoneal tumors with cavoatrial involvement can be challenging. Completeness of resection of the cava tumor extension is crucial for the patient's survival. We report a monocentric experience with the use of cardiopulmonary bypass and deep hypothermic low flow for the surgical resection of caval and atrial involvement of retroperitoneal tumors.
  
  
  METHODS
  Between 2006 and 2011, 9 patients were admitted in our cardiovascular surgery department for retroperitoneal tumors with cavoatrial extension. Every case was performed with cardiopulmonary bypass under deep hypothermia (18°C) with a continuous low-flow perfusion (1 to 1.5 L/min). Cardiopulmonary bypass output was tuned to obtain a nearly bloodless field. Reconstruction of the atriohepatic confluent was carried out with a pericardium patch without inferior vena cava reconstruction.
  
  
  RESULTS
  There was no perioperative death. Mean duration of deep hypothermic low flow was 52.2 ± 18.2 minutes. The lowest mean esophageal temperature obtained during procedure was 18.2° ± 1.4°C. No neurologic event was noted postoperatively. Three patients had early complications: one reintervention for bleeding, one reintervention for mediastinitis, and one transient moderate renal failure. After a year, all patients were alive with patent atriohepatic reconstruction.
  
  
  CONCLUSIONS
  Cardiopulmonary bypass with deep hypothermic low flow facilitates tumor resection and reconstruction of the atriohepatic confluent. It provides satisfactory postoperative results. It should be considered as an option in the management of these retroperitoneal tumors with cavoatrial involvement.
authors.affiliation: Department of Cardiovascular Surgery, European Hospital Georges Pompidou, Assistance Publique des Hôpitaux de Paris, and Paris Descartes University, Paris, France.
authors.forename: Jean-Noel
authors.initials: JN
authors.lastname: Fabiani
authors.forename: Maxime
authors.initials: M
authors.lastname: Raux
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Alsac
authors.forename: Leonora
authors.initials: L
authors.lastname: Du Puymontbrun
authors.forename: Alain
authors.initials: A
authors.lastname: Bel
authors.forename: Jérome
authors.initials: J
authors.lastname: Jouan
authors.forename: Suzanna
authors.initials: S
authors.lastname: Salvi
authors.forename: Julia
authors.initials: J
authors.lastname: Pouly
authors.forename: Paul
authors.initials: P
authors.lastname: Achouh
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery; D007813:Laparotomy / Q000379:methods; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000473:pathology / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods; D012186:Retroperitoneal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D056346:Sternotomy / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*; D055815:Young Adult